Group 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: 232707

Information Collection (IC) Details

View Information Collection (IC)

Group Outreach Education Form
 
No New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 4 Group Outreach and Education Form Grp OutreachEduc form.pdf Yes Yes Fillable Fileable

Community and Social Services Social Services

 

49,000 0
   
Individuals or Households
 
   0 %

  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 49,000 0 0 0
Annual IC Time Burden (Hours) 2,164 0 2,164 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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