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Federal forms, ICRs, and supporting documents

Information Collection

Survey of Medicaid Home and Community-Based Services Waiver and Personal Care Option Recipients for the Multi-Site Study of Medicaid HOme and Community-Based Services

IC 37913 under ICR 200402-0938-015 · OMB 0938-0826.

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Information Collection (IC) Details

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Information Collection Instruments:
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Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HCFA-10018 Yes Yes

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 4,800 0 0 0 0 4,800
Annual IC Time Burden (Hours) 3,200 0 0 0 0 3,200
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
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Title Document Date Uploaded
 
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.