Information Collection

Income and Eligibility Verification System Reporting and Supporting Regulations in 42 CFR 431.17, 431.306, 435.910, 435.920, 435.940-435.960

IC 8088 under ICR 199903-0938-003 · OMB 0938-0467.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type

No indexed documents/forms are available for this IC yet. A refresh has been queued.

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Income and Eligibility Verification System Reporting and Supporting Regulations in 42 CFR 431.17, 431.306, 435.910, 435.920, 435.940-435.960	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-0074				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: Individuals or Households

Percentage of Respondents Reporting Electronically: 93 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	54	0	54
Annual IC Time Burden (Hours)	129,230	-2,160	131,390
Annual IC Cost Burden (Dollars)	892,000	-269,000	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.