Information Collection

State Survey Agency Quarterly Expenditure Report - Long-term Facility Workload

IC 113983 under ICR 199001-0938-001 · OMB 0938-0562.

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Information Collection (IC) Details

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IC Title:	STATE SURVEY AGENCY QUARTERLY EXPENDITURE REPORT - LONG-TERM FACILITY WORKLOAD	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HCFA-2824				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 53	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	212	212
Annual IC Time Burden (Hours)	3,392	3,392
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

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