Information Collection

Information Collection Requirements Contained In Berc-297-fc & Related Instructions Implementing The U.s. District Court's Decision In Lynch V. Rank

IC 113589 under ICR 198702-0938-002 · OMB 0938-0377.

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Document Name	Document Type

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IC Title:

INFORMATION COLLECTION REQUIREMENTS CONTAINED IN BERC-297-FC & RELATED INSTRUCTIONS IMPLEMENTING THE U.S. DISTRICT COURT'S DECISION IN LYNCH V. RANK

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Mandatory

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-61				No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	3,500	-14,682	18,182
Annual IC Time Burden (Hours)	19,250	-80,750	100,000
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.

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