Information Collection

Part C Allocation and Expenditure forms

IC 183275 under ICR 200801-0915-001 · OMB 0915-0318.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0318 can be found here:

Documents and Forms

Document Name Document Type
Part C instructions.pdf Instruction
5 5 Part C Allocations checklist.xls Form
5a 5a Part C Allocations Report.xls Form
5b 5b Part C Expenditures checklist.xls Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Part C Allocation and Expenditure forms	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Part C instructions.pdf	Yes	No	Printable Only
Form	5	5	Part C Allocations checklist.xls	Yes	Yes	Fillable Fileable
Form	5a	5a	Part C Allocations Report.xls	Yes	Yes	Fillable Fileable
Form	5b	5b	Part C Expenditures checklist.xls	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 361	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	722	722
Annual IC Time Burden (Hours)	5,054	5,054
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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