Centenarian Project Title XVI Only

Centenarian Project and Medicare Non-Utilzation Project Development Worksheets: Face-to-Face Interview; Telephone Interview

OMB: 0960-0780

IC ID: 191770

Documents and Forms
Document Name
Document Type
Other-Interview Worksheet
Other-Interview Worksheet
Information Collection (IC) Details

View Information Collection (IC)

Centenarian Project Title XVI Only
 
No Modified
 
Voluntary
 
20 CFR 422.135 20 CFR 416.204(b)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Interview Worksheet Face-to-Face Interview Worksheet.pdf Yes No Printable Only
Other-Interview Worksheet Telephone Interview Worksheet.pdf Yes No Printable Only

Income Security General Retirement and Disability

 

194 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 194 0 0 -46 0 240
Annual IC Time Burden (Hours) 49 0 0 -11 0 60
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.

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