Income and Eligibility Verification System Reporting and 435.920, 435.940-435.960

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Information Collection (IC) Details

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IC Title:	Income and Eligibility Verification System Reporting and 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)	101,414	-27,816	129,230
Annual IC Cost Burden (Dollars)	0	-892,000	892,000

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.