Information Collection

TANF High Performance Bonus Report, Assessment of Medicaid and SCHIP Enrollment Aming Individuals After Leaving TANF Assistance

IC 10453 under ICR 200503-0992-002 · OMB 0992-0007.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

TANF High Performance Bonus Report, Assessment of Medicaid and SCHIP Enrollment Aming Individuals After Leaving TANF Assistance

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	ACF-210				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: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	216	216
Annual IC Time Burden (Hours)	4,320	4,320
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

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