Media Outreach Education Form

State Health Insurance Assistance Program (SHIP) Client Contact Form, Pubic and Media Activity Form, and Resource Report Form

OMB: 0985-0040

IC ID: 193278

Information Collection (IC) Details

View Information Collection (IC)

Media Outreach Education Form
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 2 Media Group Outreach Events Form Media OutreachEduc form.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

49,000 0
   
State, Local, and Tribal Governments
 
   100 %

  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 49,000 0 -97,959 49,000 0 97,959
Annual IC Time Burden (Hours) 2,164 0 -6,492 0 0 8,656
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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