Information Collection

Part A Allocation and Expenditures Forms

IC 183271 under ICR 201402-0915-002 · OMB 0915-0318.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0318 can be found here:

Documents and Forms

Document Name Document Type
Form A1 Part A Allocation and Expenditures Forms Form
A1 Part A and MAI Allocations Table FY14PartAAllocationsReport.xls Form
A2 Part A and MAI Allocations Table FY14PartAExpendituresReport.xlsx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Part A Allocation and Expenditures Forms	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	A1	Part A and MAI Allocations Table	FY14PartAAllocationsReport.xls		Yes	Yes	Fillable Fileable
Form	A2	Part A and MAI Allocations Table	FY14PartAExpendituresReport.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 52	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	104	-8	112
Annual IC Time Burden (Hours)	156	-740	896
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.