Information Collection

ICF/MR Survey Report Form (3070G-I) and Supporting Regulations -- 42 CFR Sections 431, 435, 440, 442, and 483, Subpart I

IC 7816 under ICR 199703-0938-003 · OMB 0938-0062.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0062 can be found here:

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Information Collection (IC) Details

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IC Title:	ICF/MR Survey Report Form (3070G-I) and Supporting Regulations -- 42 CFR Sections 431, 435, 440, 442, and 483, Subpart I	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	3070G-I				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,200	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 Agency Discretion
Annual Number of Responses for this IC	7,200	7,200
Annual IC Time Burden (Hours)	21,600	21,600
Annual IC Cost Burden (Dollars)	0	0

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