Information Collection

Exemption for States with High Managed Care Enrollment (§§447.203(b) and 447.204(a) through (c))

IC 230976 under ICR 201804-0938-004 · OMB 0938-1134.

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Information Collection (IC) Details

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IC Title:	Exemption for States with High Managed Care Enrollment (§§447.203(b) and 447.204(a) through (c))	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 447.203(b) 42 CFR 447.204(a) through (c)

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: 17	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	17	17
Annual IC Time Burden (Hours)	9	9
Annual IC Cost Burden (Dollars)	0	0

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