Information Collection

Cost Data collection

IC 202869 under ICR 201206-2528-001 · OMB 2528-0290.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
HCV Admin Fee_OMB Full Study_Appendix B_6-22-12.docx	Other-Cost Data Collection
HCV Admin Fee_OMB Full Study_Appendix B_11-19-12.docx	Other-Cost Data Collection

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

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
Other-Cost Data Collection			HCV Admin Fee_OMB Full Study_Appendix B_11-19-12.docx		No		Paper Only
Other-Cost Data Collection			HCV Admin Fee_OMB Full Study_Appendix B_6-22-12.docx		No		Paper Only

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 120

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	2,400	2,400
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.