Information Collection

Information Collection Requirements Contained In 42 Cfr, Sections 447.413 And 447.415 (bpo-07-f)

IC 113650 under ICR 198411-0938-002 · OMB 0938-0397.

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IC Title:

INFORMATION COLLECTION REQUIREMENTS CONTAINED IN 42 CFR, SECTIONS 447.413 AND 447.415 (BPO-07-F)

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	HCFA-R-56				No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 57

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	102,000	102,000
Annual IC Time Burden (Hours)	10,200	10,200
Annual IC Cost Burden (Dollars)	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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