Information Collection

MAI Report for Part B

IC 183274 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form 4b MAI Report for Part B	Form
Instructions for PART B (with EHBs Instructions).doc	Instruction
4b Part B Expenditures Report Part B Expendiutres Report.xls	Form
4a Part B Allocations Report Part B Allocations Report.xls	Form

IC Title:

MAI Report for Part B

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	4b	Part B Expenditures Report	Part B Expendiutres Report.xls	Yes	Yes	Fillable Fileable
Instruction			Instructions for PART B (with EHBs Instructions).doc	Yes	No	Printable Only
Form	4a	Part B Allocations Report	Part B Allocations 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: 59

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-118	118
Annual IC Time Burden (Hours)	-472	472
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.