Information Collection

Evaluation Of The Ssop Medicare Demonstrations In Detroit And New York And The Medicaid Program In Massachusetts

IC 112972 under ICR 198102-0938-002 · OMB 0938-0149.

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Document Name	Document Type

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IC Title:

EVALUATION OF THE SSOP MEDICARE DEMONSTRATIONS IN DETROIT AND NEW YORK AND THE MEDICAID PROGRAM IN MASSACHUSETTS

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	HCFA-254	No	No
Form	HCFA-250	No	No
Form	THRU	No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20,623

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20,623	20,623
Annual IC Time Burden (Hours)	5,269	5,269
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.