OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

A Scan of the Status of States' Integration of Human Services and Health Insurance Programs

IC 220612 under ICR 201704-0990-009 · OMB 0990-0421.

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

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A Scan of the Status of States' Integration of Human Services and Health Insurance Programs
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-survey 0990-0421Attachment A_Questionnaire and Instructions_state integration 3_14_16.docx Yes Yes Fillable Printable

Health Health Care Services

 

92 0
   
State, Local, and Tribal Governments
 
   100 %

  Requested 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 46 0 0 0 0 46
Annual IC Time Burden (Hours) 35 0 0 0 0 35
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
A Scan of the Status of States’ Integration of Human Services and Health Insurance Programs 0990-0421 SS_A_ASPE Generic_state integration 3_14_16.docx 03/14/2016
A Scan of the Status of States’ Integration of Human Services and Health Insurance Programs 0990-0421SS_B_ASPE Generic_state integration 3_14_16.docx 03/14/2016
A Scan of the Status of States’ Integration of Human Services and Health Insurance Programs 0990-0421Cover Sheet_ASPE Generic_state integration 3_14_16.docx 03/14/2016
EMAIL_A Scan of the Status of States’ Integration of Human Services and Health Insurance Programs 0990-0421Attachment C_email with link to respondents_state integration 3_14_16.docx 03/14/2016
A Scan of the Status of States’ Integration of Human Services and Health Insurance Programs 0990-0421Attachment B_letter to respondents_state integration 3_14_16.docx 03/14/2016
A Scan of the Status of States’ Integration of Human Services and Health Insurance Programs 0990-0421Attachment D_APHSA letter to respondents_state integration 3_14_16.docx 03/14/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.