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Information Collection

Contractors Information On Collections-regional Office Program Validation Reviews Of Providers And Medicaid Agencies

IC 113108 under ICR 198209-0938-004 · OMB 0938-0208.

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CONTRACTORS INFORMATION ON COLLECTIONS-REGIONAL OFFICE PROGRAM VALIDATION REVIEWS OF PROVIDERS AND MEDICAID AGENCIES
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 9012 No No


    

400 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 400 0 0 270 0 130
Annual IC Time Burden (Hours) 1,200 0 0 810 0 390
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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