OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Key Informats (screening)

IC 199549 under ICR 201307-0925-004 · OMB 0925-0649.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Key Informats (screening)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 6 KI Screening Protocol Overview FINAL_HCS_SSA_ATTACH 12_KI SCREENING_Jan 2013.docx No No Paper Only

Health Health Care Services

 

3,520 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 3,520 0 0 1,913 0 1,607
Annual IC Time Burden (Hours) 293 0 0 164 0 129
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
FINAL_HCS_SSA_ATTACH 11_KI BROCHURE_Jan 2013 FINAL_HCS_SSA_ATTACH 11_KI BROCHURE_Jan 2013.docx 07/24/2013
FINAL_HCS_SSA_ATTACH 10_KI LETTER_Jan 2013 FINAL_HCS_SSA_ATTACH 10_KI LETTER_Jan 2013.docx 07/24/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.