Information Collection

42 Cfr 425.121 - Individuals In States Using More Restrictive Requirements For Medicaid Than The Ssi Requirements (state Plan Preprint)

IC 113067 under ICR 198301-0938-005 · OMB 0938-0193.

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Information Collection (IC) Details

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IC Title:	42 CFR 425.121 - INDIVIDUALS IN STATES USING MORE RESTRICTIVE REQUIREMENTS FOR MEDICAID THAN THE SSI REQUIREMENTS (STATE PLAN PREPRINT)	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HCFA-179				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 54	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	Previously Approved
Annual Number of Responses for this IC	862	54	808
Annual IC Time Burden (Hours)	3,478	54	3,424
Annual IC Cost Burden (Dollars)	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.