Information Collection

Information Collection Requirements In Hsq-108-f, Pro Assumption Of Responsibilities 42 Cfr 405.472, 431.630, 456.654, 466.70, 466.72, 466.74, 466.78, 466.80 & 466.94

IC 113670 under ICR 198503-0938-003 · OMB unassigned.

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IC Title:

INFORMATION COLLECTION REQUIREMENTS IN HSQ-108-F, PRO ASSUMPTION OF RESPONSIBILITIES 42 CFR 405.472, 431.630, 456.654, 466.70, 466.72, 466.74, 466.78, 466.80 & 466.94

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-71				No	No

Federal Enterprise Architecture Business Reference Module

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 0

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	0	0	0	0	0	0
Annual IC Time Burden (Hours)	0	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

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