Information Collection

Bounceback Forms for www.Medicare.gov, www.4woman.gov, and www.healthfinder.gov

IC 8469 under ICR 199904-0938-003 · OMB 0938-0756.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0756 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Bounceback Forms for www.Medicare.gov, www.4woman.gov, and www.healthfinder.gov	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

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-268				Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 636,555	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	212,185	212,185
Annual IC Time Burden (Hours)	21,221	21,221
Annual IC Cost Burden (Dollars)	0	0

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.