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 And 466.94

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 AND 466.94

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Documents and Forms

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Information Collection (IC) Details

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 AND 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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HCFA-R-71				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: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	54	54
Annual IC Time Burden (Hours)	139,683	139,683
Annual IC Cost Burden (Dollars)	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.