Information Collection

Supporting Statement For Information Collection Requirements In Berc 321-f And Bqc-071-fc Income And Eligibility Verification System (ievs)

IC 113800 under ICR 198904-0938-009 · OMB 0938-0467.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0467 can be found here:

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Information Collection (IC) Details

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IC Title:	SUPPORTING STATEMENT FOR INFORMATION COLLECTION REQUIREMENTS IN BERC 321-F AND BQC-071-FC INCOME AND ELIGIBILITY VERIFICATION SYSTEM (IEVS)	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-74				No	No

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: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	54	-1	55
Annual IC Time Burden (Hours)	99,577	-66,115	165,692
Annual IC Cost Burden (Dollars)	0	0	0

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