OMB
.report
Search
Quarterly Reports
American Health Benefit Exchange State Planning and Establishment Grants
OMB: 0938-1101
IC ID: 193864
OMB.report
HHS/CMS
OMB 0938-1101
ICR 201009-0938-009
IC 193864
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1101 can be found here:
2011-01-13 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Quarterly Reports
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
56
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
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
224
0
0
0
0
224
Annual IC Time Burden (Hours)
9,408
0
0
0
0
9,408
Annual IC Cost Burden (Dollars)
303,576
0
0
0
0
303,576
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.