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 166242 under ICR 198608-0938-013 · OMB 0938-0295.

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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:

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 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 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	50	0	50
Annual IC Time Burden (Hours)	24,825	8,600	16,225
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

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