Information Collection

THCGME Reconciliation Tool

IC 197986 under ICR 201106-0915-001 · OMB 0915-0342.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0342 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 THCGME Reconciliation Tool	Form
1 Reconciliation Tool Reconciliation_Tool 052611.docx	Form
Reconciliation_Tool_Instructions 052611.docx Instructions for Reconciliation Tool	IC Document

IC Title:

THCGME Reconciliation Tool

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Reconciliation Tool	Reconciliation_Tool 052611.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 51

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	51	51
Annual IC Time Burden (Hours)	255	255
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Instructions for Reconciliation Tool	Reconciliation_Tool_Instructions 052611.docx	06/02/2011

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