Information Collection Request

Financial Disclosure for Reasonable and Affordable Rehabilitation Payments Form

ICR 201402-1845-005 · OMB 1845-0120 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 1845-0000 Financial Disclosure for Reasonable and Affordable Rehabilitation Payments Form Form and Instruction Modified Available
Supp_Statement_RAAR_form_1_27_14_final[1].docx Supporting Statement A Uploaded 2014-02-20 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
207947 Financial Disclosure for Reasonable and Affordable Rehabilitation Payments Form Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2017 36 Months From Approved
35,282 0 0
35,282 0 0
0 0 0





Reginfo record details
1
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IC Title Form No. Form Name
Financial Disclosure for Reasonable and Affordable Rehabilitation Payments Form 1845-0000 Financial Disclosure for Reasonable and Affordable Rehabilitation Payments

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 35,282 0 0 35,282 0 0
Annual Time Burden (Hours) 35,282 0 0 35,282 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No