Title V Survey

Estimating the Gap Between the Needs of Children and Health Coverage and Benefits Through Implementation of the Affordable Care Act

OMB: 0915-0369

IC ID: 208301

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Form and Instruction
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Title V Survey
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 survey Title V Survey.docx Yes Yes Fillable Fileable

Health Illness Prevention

 

52 0
   
State, Local, and Tribal Governments
 
   100 %

  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 52 0 52 0 0 0
Annual IC Time Burden (Hours) 1,872 0 1,872 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
5 5.a. Prenotification E-mail_mr.docx 07/31/2013
5 5.b. Cover E-mail_mr.docx 07/31/2013
5 5.e. Reminder Email_mr.docx 07/31/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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