Direct Verification Evaluation Study

Documents and Forms

Document Name Document Type
AppxB SA & Medicaid Interview Guides.pdf Other-Interview Guide-SA CN & Medica
AppxC LEA Info Brochure.pdf Other-Brochure-LEA
Appx E LEA Survey.pdf Other-Survey-LEA
Appx F LEA Telephone Inverview.pdf Other-Interview Guide-LEA
AppxD LEA Brochure Nonresponse.pdf Other-Brochure

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Direct Verification Evaluation Study	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-Interview Guide-SA CN & Medicaid	AppxB SA & Medicaid Interview Guides.pdf	No	Paper Only
Other-Brochure-LEA	AppxC LEA Info Brochure.pdf	No	Paper Only
Other-Survey-LEA	Appx E LEA Survey.pdf	No	Paper Only
Other-Interview Guide-LEA	Appx F LEA Telephone Inverview.pdf	No	Paper Only
Other-Brochure	AppxD LEA Brochure Nonresponse.pdf	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 364	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	639	639
Annual IC Time Burden (Hours)	379	379
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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