Information Collection

Action Transmittal To Medicaid State Agencies Implementing The Decision Of The U.s. District Court, District Of Northern California, In The Case Of Lynch V. Rank

IC 113588 under ICR 198410-0938-009 · OMB 0938-0377.

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Information Collection (IC) Details

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IC Title:	ACTION TRANSMITTAL TO MEDICAID STATE AGENCIES IMPLEMENTING THE DECISION OF THE U.S. DISTRICT COURT, DISTRICT OF NORTHERN CALIFORNIA, IN THE CASE OF LYNCH V. RANK	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HCFA-R-61				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 45	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	45	44	1
Annual IC Time Burden (Hours)	366,345	366,344	1
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.