Information Collection

Multiple Payer Transmittal For Magnetic Media Reporting

IC 129839 under ICR 198108-1545-193 · OMB 1545-0398.

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Information Collection (IC) Details

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IC Title:	MULTIPLE PAYER TRANSMITTAL FOR MAGNETIC MEDIA REPORTING	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	FORMS 4802,	No	No
Form	4802 PR	No	No
Form	& 4802 SS	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,425	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	68,500	68,500
Annual IC Time Burden (Hours)	13,700	13,700
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

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