Information Collection

Information Collection Requirements In 42 Cfr Part 434, Subparts A Thru E, Medicaid Contracts With Health Maintenance Organizations (hmos) & Prepaid Health Plans

IC 113431 under ICR 198601-0938-002 · OMB 0938-0326.

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Information Collection (IC) Details

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IC Title:

INFORMATION COLLECTION REQUIREMENTS IN 42 CFR PART 434, SUBPARTS A THRU E, MEDICAID CONTRACTS WITH HEALTH MAINTENANCE ORGANIZATIONS (HMOS) & PREPAID HEALTH PLANS

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-27				No	No
Form	R-28				No	No

Federal Enterprise Architecture Business Reference Module

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 90

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	90	90
Annual IC Time Burden (Hours)	40,246	40,246
Annual IC Cost Burden (Dollars)	0	0

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