Information Collection

Medicaid - Information Collection Requirements In Hsq-127-f 42 Cfr Sections 442.114(a), 441.115(a) And 442.116(a)(c) And (d)

IC 113915 under ICR 198802-0938-002 · OMB 0938-0521.

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Information Collection (IC) Details

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IC Title:	MEDICAID - INFORMATION COLLECTION REQUIREMENTS IN HSQ-127-F 42 CFR SECTIONS 442.114(A), 441.115(A) AND 442.116(A)(C) AND (D)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

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-108				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	15	15
Annual IC Time Burden (Hours)	263	263
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.