Information Collection

Medicaid Sterilization Regulations and Consent Form and Supporting Regulations -- 45 CFR 96.73, 42 CFR 441, Subpart F

IC 8104 under ICR 199710-0938-006 · OMB 0938-0481.

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Information Collection (IC) Details

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IC Title:	Medicaid Sterilization Regulations and Consent Form and Supporting Regulations -- 45 CFR 96.73, 42 CFR 441, Subpart F	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-94				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 112,526	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	112,526	-90,510	203,036
Annual IC Time Burden (Hours)	140,658	-62,378	203,036
Annual IC Cost Burden (Dollars)	0	0	0

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