Information Collection

Information Collection Requirements in HSQ-108F Assumption of Responsibilities and Supporting Regulations in 42 CFR Sections 412.44, 412.46, 431.630, 456.654, 466.71, 466.73, 466.74, 466.78

IC 8055 under ICR 199901-0938-008 · OMB 0938-0445.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0445 can be found here:

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Information Collection (IC) Details

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IC Title:	Information Collection Requirements in HSQ-108F Assumption of Responsibilities and Supporting Regulations in 42 CFR Sections 412.44, 412.46, 431.630, 456.654, 466.71, 466.73, 466.74, 466.78	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-71				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,471	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	6,417	5,537	880
Annual IC Time Burden (Hours)	46,834	181	46,653
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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