Information Collection

Information Collection Requirements Contained In 442.307, 442.308, 442.309, 442.313, 442.314, 442.318, 442.319, And 442.320, 442.311-condit. Of Participat. For Intermed. Fam.

IC 113570 under ICR 198607-0938-002 · OMB 0938-0370.

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Information Collection (IC) Details

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IC Title:	INFORMATION COLLECTION REQUIREMENTS CONTAINED IN 442.307, 442.308, 442.309, 442.313, 442.314, 442.318, 442.319, AND 442.320, 442.311-CONDIT. OF PARTICIPAT. FOR INTERMED. FAM.	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-45				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 11,105	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	11,105	11,105
Annual IC Time Burden (Hours)	2,430,038	2,430,038
Annual IC Cost Burden (Dollars)	0	0

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.