OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Information Collection Requirements In Bqc-64-f, State Plan Requirements And Other Provisions Relating To Third-party Liability (tpl) Programs

IC 113973 under ICR 199301-0938-002 · OMB 0938-0555.

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)

INFORMATION COLLECTION REQUIREMENTS IN BQC-64-F, STATE PLAN REQUIREMENTS AND OTHER PROVISIONS RELATING TO THIRD-PARTY LIABILITY (TPL) PROGRAMS
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HCFA-R-122 No No


    

55 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 55 0 0 55 0 0
Annual IC Time Burden (Hours) 55 0 0 55 0 0
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.