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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

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.