Information Collection

Pretesting for Direct Certification with Medicaid Demonstrations

IC 223971 under ICR 201503-0584-004 · OMB 0584-0606.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0584-0606 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
DCM-FRP Generic OMB Appendix A1.docx	Other-DCM-FRP Generic OMB Appendix A
DCM-FRP Generic OMB Appendix A2.docx	Other-DCM-FRP Generic OMB Appendix A
DCM-FRP Generic OMB Appendix A3.docx	Other-DCM-FRP Generic OMB Appendix A
DCM-FRP Generic OMB Appendix A4.docx	Other-DCM-FRP Generic OMB Appendix A
DCM-FRP Generic OMB Appendix B.docx	Other-DCM-FRP Generic OMB Appendix B
DCM-FRP Generic OMB Appendix C1.docx	Other-DCM-FRP Generic OMB Appendix C
DCM-FRP Generic OMB Appendix C1a.xlsx	Other-DCM-FRP Generic OMB Appendix C
DCM-FRP Generic OMB Appendix C1b.xlsx	Other-DCM-FRP Generic OMB Appendix C
DCM-FRP Generic OMB Appendix C2.docx	Other-DCM-FRP Generic OMB Appendix C
DCM-FRP Generic OMB Appendix D.docx	Other-DCM-FRP Generic OMB Appendix D
DCM-FRP Generic OMB Memo.docx DCM-FRP Generic OMB Memo	IC Document

IC Title:

Pretesting for Direct Certification with Medicaid Demonstrations

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Other-DCM-FRP Generic OMB Appendix A2	DCM-FRP Generic OMB Appendix A2.docx	No	Paper Only
Other-DCM-FRP Generic OMB Appendix A3	DCM-FRP Generic OMB Appendix A3.docx	No	Paper Only
Other-DCM-FRP Generic OMB Appendix A4	DCM-FRP Generic OMB Appendix A4.docx	No	Paper Only
Other-DCM-FRP Generic OMB Appendix B	DCM-FRP Generic OMB Appendix B.docx	No	Paper Only
Other-DCM-FRP Generic OMB Appendix C1	DCM-FRP Generic OMB Appendix C1.docx	No	Paper Only
Other-DCM-FRP Generic OMB Appendix C1a	DCM-FRP Generic OMB Appendix C1a.xlsx	No	Paper Only
Other-DCM-FRP Generic OMB Appendix C1b	DCM-FRP Generic OMB Appendix C1b.xlsx	No	Paper Only
Other-DCM-FRP Generic OMB Appendix C2	DCM-FRP Generic OMB Appendix C2.docx	No	Paper Only
Other-DCM-FRP Generic OMB Appendix D	DCM-FRP Generic OMB Appendix D.docx	No	Paper Only
Other-DCM-FRP Generic OMB Appendix A1	DCM-FRP Generic OMB Appendix A1.docx	No	Paper Only

Line of Business: Income Security

Subfunction: Food and Nutrition Assistance

Privacy Act System of Records

Title: FNS-8 USDA/FNS Studies and Reports

FR Citation: 56 FR 19078

Number of Respondents: 96

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	345	345
Annual IC Time Burden (Hours)	404	404
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
DCM-FRP Generic OMB Memo	DCM-FRP Generic OMB Memo.docx	10/24/2016

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