Information Collection

Part A Allocation and Expenditures Forms

IC 183271 under ICR 201703-0915-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Part A Allocations Report - instructions.docx	Instruction
A1 Part A Allocations Report.xlsx Part A Allocations Report 6MAR2017 Final.xlsx	Form
A2 Part A Expenditures Report.xlsx Part A Expenditures Report 6MAR2017 Final.xlsx	Form

IC Title:

Part A Allocation and Expenditures 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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Part A Allocations Report - instructions.docx	Yes	Yes	Fillable Fileable
Form	A1	Part A Allocations Report.xlsx	Part A Allocations Report 6MAR2017 Final.xlsx	Yes	Yes	Fillable Fileable
Form	A2	Part A Expenditures Report.xlsx	Part A Expenditures Report 6MAR2017 Final.xlsx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 52

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
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	104	0	104
Annual IC Time Burden (Hours)	312	156	156
Annual IC Cost Burden (Dollars)	0	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.