155.220(c)(3)(vii)

Program Integrity and Additional State Information Collections

OMB: 0938-1213

IC ID: 208516

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Information Collection (IC) Details

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155.220(c)(3)(vii)
 
No Modified
 
Required to Obtain or Retain Benefits
 
45 CFR 155.220

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability

Health Health Care Services

 

50 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 50 50 0 0 0 0
Annual IC Time Burden (Hours) 800 800 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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