Form 13560, HCTC Health Plan Administrator (HPA) Return of Funds Form

Form 13560, Health Plan Administrator (HPA) Return of Funds

OMB: 1545-1891

IC ID: 19574

Information Collection (IC) Details

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Form 13560, HCTC Health Plan Administrator (HPA) Return of Funds Form
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 13560 Health Plan Administrator (HPA) Return of Funds f13560--2017-05-00.pdf Yes No Fillable Printable

General Government Taxation Management

 

200 0
   
State, Local, and Tribal Governments
 
   0 %

  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 200 0 0 0 0 200
Annual IC Time Burden (Hours) 50 0 0 0 0 50
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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