Information Collection

Revisions To The Medicaid State Plan Preprint, Supplement 9 To Attachment 2.6-a, For Transfer Of Resources

IC 113068 under ICR 198408-0938-013 · OMB 0938-0193.

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Information Collection (IC) Details

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IC Title:	REVISIONS TO THE MEDICAID STATE PLAN PREPRINT, SUPPLEMENT 9 TO ATTACHMENT 2.6-A, FOR TRANSFER OF RESOURCES	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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	54	-808	862
Annual IC Time Burden (Hours)	3,640	162	3,478
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.