Information Collection

State Survey Agency Budget/expenditure Report, State Agency Certification Workload Report

IC 114105 under ICR 199310-0938-014 · OMB 0938-0642.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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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:

table that charts list of 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

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	212	212
Annual IC Time Burden (Hours)	11,872	11,872
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

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