OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Consolidated FFR

IC 222174 under ICR 201603-4040-001 · OMB 4040-0017.

Documents and Forms
Document Name
Document Type
Other-Survey
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Consolidated FFR
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Survey HHS DAP_Consolidated FFR Discussion Survey 06242016.docx Yes Yes Fillable Fileable

Health Health Care Services

 

90 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 90 0 90 0 0 0
Annual IC Time Burden (Hours) 15 0 15 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Short Supporting Statement 4040-0017_Short Supporting Statement CFFR Discussion_060816.docx 06/24/2016
Supporting Statement A 4040-0017_SupportingStatement A CFFR Discussion_06082016.docx 06/24/2016
CFFR Discussion PowerPoint Presentation DRAFT_HHS DAP CFFR Discussion_v3_Draft_06242016.pptx 06/24/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.