Information Collection

System Programming (Plans) (section 423.120(c)(6))

IC 231339 under ICR 201803-0938-004 · OMB 0938-0964.

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Information Collection (IC) Details

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IC Title:	System Programming (Plans) (section 423.120(c)(6))	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 423.120(c)(6)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	93,600	93,600
Annual IC Cost Burden (Dollars)	0	0

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