Information Collection

New Freedom Initiative - Web-based Reporting System for Grantees

IC 8841 under ICR 201210-0938-006 · OMB 0938-0979.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10161 Real Choice Systems Change Grants Web-Based Reporting System FFY 2005 Annual Report New Freedom Initiative - Web-based Reporting System for Grantees	Form and Instruction
CMS-10161 Real Choice Systems Change Grants Web-Based Reporting Sy 2005 Sys Change Annual for OMB.ppt	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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 and Instruction	CMS-10161				No	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 171

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	428	428
Annual IC Time Burden (Hours)	3,764	3,764
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.

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