Information Collection

Income and Eligibility Verification System (IEVS) Information Collection Requirements in 42 CFR 435.940-435.965

IC 8087 under ICR 199602-0938-008 · OMB 0938-0467.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0467 can be found here:

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Information Collection (IC) Details

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IC Title:	Income and Eligibility Verification System (IEVS) Information Collection Requirements in 42 CFR 435.940-435.965	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-R-74				Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 54	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 93 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	54	54
Annual IC Time Burden (Hours)	131,390	131,390
Annual IC Cost Burden (Dollars)	1,161,000	1,161,000

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.