Information Collection

Eligibility Verification (42 CFR 435.945, 435.948, 435.956, 457.350, and 457.380)

IC 199156 under ICR 201203-0938-012 · OMB 0938-1147.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1147 can be found here:

Documents and Forms

Document Name Document Type

No indexed documents/forms are available for this IC yet. A refresh has been queued.

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Eligibility Verification (42 CFR 435.945, 435.948, 435.956, 457.350, and 457.380)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 435 and 457

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 53	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Program Change Due to New Statute	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	53	-53
Annual IC Time Burden (Hours)	1,590	-1,590
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.