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State Survey Agency Budget/expenditure Report, State Agency Certification Workload Report
STATE SURVEY AGENCY BUDGET/EXPENDITURE REPORT, STATE AGENCY CERTIFICATION WORKLOAD REPORT
OMB: 0938-0642
IC ID: 114105
OMB.report
HHS/CMS
OMB 0938-0642
ICR 199310-0938-014
IC 114105
( )
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
STATE SURVEY AGENCY BUDGET/EXPENDITURE REPORT, STATE AGENCY CERTIFICATION WORKLOAD REPORT
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 434
No
No
Form
HCFA 435
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
106
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 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
212
0
212
0
0
0
Annual IC Time Burden (Hours)
11,872
0
11,872
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.