Information Collection

Quarterly Showing Validation Surveys

IC 113339 under ICR 198412-0938-006 · OMB 0938-0282.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0282 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	QUARTERLY SHOWING VALIDATION SURVEYS	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-9050				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	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	54	34	20
Annual IC Time Burden (Hours)	864	544	320
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

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