Information Collection

Icr's Contained In 42 Cfr, Sections 441.56(d), 441.60(a)(4) And (5), And 441.61(a)

IC 113500 under ICR 198707-0938-005 · OMB 0938-0354.

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Information Collection (IC) Details

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IC Title:	ICR'S CONTAINED IN 42 CFR, SECTIONS 441.56(D), 441.60(A)(4) AND (5), AND 441.61(A)	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

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: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	54	0	54
Annual IC Time Burden (Hours)	3,002	-11,448	14,450
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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