Information Collection

Part D Allocation and Expenditure forms

IC 183276 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form 6 Part D Allocation and Expenditure forms	Form
Part D instructions.pdf	Instruction
6 6 Part D Allocations Report.xls	Form
6a 6a Part D Expenditures Report.xls	Form

IC Title:

Part D 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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	6	6	Part D Allocations Report.xls	Yes	Yes	Fillable Fileable
Form	6a	6a	Part D Expenditures Report.xls	Yes	Yes	Fillable Fileable
Instruction			Part D instructions.pdf	Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 90

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 New Statute
Annual Number of Responses for this IC	180	180
Annual IC Time Burden (Hours)	1,260	1,260
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.