Information Collection

Core VIPP Non-Funded SHD: SOTS Financial Module

IC 200347 under ICR 201302-0920-012 · OMB 0920-0916.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0916 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 4 Core VIPP Non-Funded SHD: SOTS Financial Module	Form and Instruction
4 Core VIPP Non-Funded SHD: SOTS Financial Module Attachment E-2 - WORD.docx	Form and Instruction

IC Title:

Core VIPP Non-Funded SHD: SOTS Financial Module

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	4	Core VIPP Non-Funded SHD: SOTS Financial Module	Attachment E-2 - WORD.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 22

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	22	22
Annual IC Time Burden (Hours)	22	22
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.