Information Collection

Contractors' Information Collections Interim Payment Adjustment Forms For Hhas

IC 113144 under ICR 198501-0938-004 · OMB 0938-0217.

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Information Collection (IC) Details

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IC Title:	CONTRACTORS' INFORMATION COLLECTIONS INTERIM PAYMENT ADJUSTMENT FORMS FOR HHAS	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-9013				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,600	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	5,600	5,600
Annual IC Time Burden (Hours)	56,000	56,000
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.