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.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

CONTRACTORS INFORMATION ON COLLECTIONS-REGIONAL OFFICE PROGRAM VALIDATION REVIEWS OF PROVIDERS AND MEDICAID AGENCIES

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	9012				No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 400

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	400	270	130
Annual IC Time Burden (Hours)	1,200	810	390
Annual IC Cost Burden (Dollars)	0	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.

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