OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Medicaid State Agency Third Party Liability Inventory Form

IC 166288 under ICR 199105-0938-020 · OMB 0938-0414.

Documents and Forms
Document Name
Document Type
No indexed documents/forms are available for this IC yet. A refresh has been queued.
Information Collection (IC) Details

View Information Collection (IC)

MEDICAID STATE AGENCY THIRD PARTY LIABILITY INVENTORY FORM
 
No Migrated
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HCFA-464 No No


    

56 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 56 0 0 0 0 56
Annual IC Time Burden (Hours) 448 0 0 0 0 448
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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