Information Collection

Part D Allocation and Expenditure forms

IC 183276 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⚠️ Notice: This information collection may be referencing outdated material.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 D1 Part D Allocation and Expenditure forms Form
D1 PartDAllocationsReport FY14PartDAllocationsReport.xls Form
D2 PartDExpendituresReport FY14PartDExpendituresReport.xls Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Part D Allocation and Expenditure 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	D1	PartDAllocationsReport	FY14PartDAllocationsReport.xls		Yes	Yes	Fillable Fileable
Form	D2	PartDExpendituresReport	FY14PartDExpendituresReport.xls		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 115	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	230	50	180
Annual IC Time Burden (Hours)	1,035	-225	1,260
Annual IC Cost Burden (Dollars)	0	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.