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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Information Collection (IC) Details

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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:

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 %

	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

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Title	Document	Date Uploaded

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