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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.