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Medicaid Quality Control Third Party Resource Worksheet (hcfa 301c) - (addendum) Third Party Liability Review Worksheet (hcfa-301d)

IC 112922 under ICR 198308-0938-007 · OMB 0938-0108.

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MEDICAID QUALITY CONTROL THIRD PARTY RESOURCE WORKSHEET (HCFA 301C) - (ADDENDUM) THIRD PARTY LIABILITY REVIEW WORKSHEET (HCFA-301D)
 
No Migrated
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HCFA-301C No No


    

200,000 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 200,000 0 0 200,000 0 0
Annual IC Time Burden (Hours) 52,192 0 0 52,192 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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