Information Collection

Part D Allocation and Expenditure forms

IC 183276 under ICR 201709-0915-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form D1 Part D Allocation and Expenditure forms Form
D1 Part D Allocations Report 27FEB2017 Final.xlsx Part D Allocations Report 27FEB2017 Final.xlsx Form
D2 Part D Expenditures Report 27FEB2017 Final.xlsx Part D Expenditures Report 27FEB2017 Final.xlsx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Part D Allocation and Expenditure forms	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	D1	Part D Allocations Report 27FEB2017 Final.xlsx	Part D Allocations Report 27FEB2017 Final.xlsx		Yes	Yes	Fillable Fileable
Form	D2	Part D Expenditures Report 27FEB2017 Final.xlsx	Part D Expenditures Report 27FEB2017 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: 116	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	232	232
Annual IC Time Burden (Hours)	464	464
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.