Information Collection

Discussion Guides

IC 207739 under ICR 201307-0915-002 · OMB 0915-0365.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Discussion Guides	Form and Instruction
1 State medicaid Agency Groups B_Medicaid Discussion Guide.docx	Form and Instruction
2 RW Part A Administrators and Members of Planning Council C_RW PART A Discussion Guide.docx	Form and Instruction
4 RW Clinical Providers E_RW PART C Discussion Guide.docx	Form and Instruction
3 RW Part B and ADAP D_RW PART B Discussion Guide.docx	Form and Instruction

IC Title:

Discussion Guides

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	State medicaid Agency Groups	B_Medicaid Discussion Guide.docx	Yes	Yes	Paper Only
Form and Instruction	2	RW Part A Administrators and Members of Planning Councils	C_RW PART A Discussion Guide.docx	Yes	Yes	Paper Only
Form and Instruction	4	RW Clinical Providers	E_RW PART C Discussion Guide.docx	Yes	Yes	Paper Only
Form and Instruction	3	RW Part B and ADAP	D_RW PART B Discussion Guide.docx	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 280

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	280	280
Annual IC Time Burden (Hours)	560	560
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.