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

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

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Information Collection (IC) Details

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STATE SURVEY AGENCY BUDGET/EXPENDITURE REPORT, STATE AGENCY CERTIFICATION WORKLOAD REPORT
 
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 434 No No
Form HCFA 435 No No


    

106 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 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

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