Information Collection

Freedom Of Choice: Waivers Of And Exceptions To State Plan Requirements, 42 Cfr 431.54(f)(3) And 431.55(b)(2)

IC 113371 under ICR 198506-0938-015 · OMB 0938-0295.

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Information Collection (IC) Details

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IC Title:	FREEDOM OF CHOICE: WAIVERS OF AND EXCEPTIONS TO STATE PLAN REQUIREMENTS, 42 CFR 431.54(F)(3) AND 431.55(B)(2)	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 8002				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	16,225	16,225
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.