OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

State official responsible for administering the Medicaid Program

IC 181792 under ICR 200708-0990-003 · OMB 0990-0320.

Documents and Forms
Document Name
Document Type
Other-Medicaid Survey
Other-Medicaid Survey
Information Collection (IC) Details

View Information Collection (IC)

State official responsible for administering the Medicaid Program
 
Yes New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Medicaid Survey 0990-Homelessness Data - Survey 1 (Medicaid - do include) 8-9-2007.doc No No Paper Only
Other-Medicaid Survey 0990-Homelessness Data - Survey 2 (Medicaid - do not include) 8-9-2007.doc No No Paper Only

Community and Social Services Community and Regional Development

 

51 0
   
State, Local, and Tribal Governments
 
   0 %

  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 51 0 51 0 0 0
Annual IC Time Burden (Hours) 51 0 51 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.