Information Collection

MAI report for Part A

IC 183272 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⚠️ Notice: This information collection may be referencing outdated material.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 2 MAI report for Part A Form
Instructions for PART A (with EHBs Instructions).doc Instruction
2 Part A Allocations Report and Checklist Part A Allocations Report.xls Form
3 Part A Expenditures Report and Checklist Part A Expenditures Report.xls Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	MAI report for Part A	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	2	Part A Allocations Report and Checklist	Part A Allocations Report.xls	Yes	Yes	Fillable Fileable
Instruction			Instructions for PART A (with EHBs Instructions).doc	Yes	No	Fillable Printable
Form	3	Part A Expenditures Report and Checklist	Part A Expenditures Report.xls	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 56	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-112	112
Annual IC Time Burden (Hours)	-448	448
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.