Information Collection

Discussion Guides

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.