Health Care Program Violations Notification Form

HEALTH CARE PROGRAM VIOLATIONS NOTIFICATION FORM

OMB: 0990-0141

IC ID: 167056

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HEALTH CARE PROGRAM VIOLATIONS NOTIFICATION FORM
 
No Migrated
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability


    

450 0
   
State, Local, and Tribal Governments
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 450 0 0 0 0 450
Annual IC Time Burden (Hours) 38 0 0 0 0 38
Annual IC Cost Burden (Dollars) 0 0 0 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.

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