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Federal forms, ICRs, and supporting documents

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Application for Digital-to-Analog Converter Box Coupons for Nursing Home Residents

IC 184582 under ICR 200809-0660-002 · OMB 0660-0027.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Information Collection (IC) Details

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Application for Digital-to-Analog Converter Box Coupons for Nursing Home Residents
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction None Application for Converter Box Coupons for Nursing Home Residents 0660.Draft Nursing Home Coupon Application.Rev.090908.doc Yes No Fillable Printable

General Government Executive Functions

 

414,000 0
   
Individuals or Households
 
   50 %

  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 414,000 0 414,000 0 0 0
Annual IC Time Burden (Hours) 138,000 0 138,000 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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