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Federal forms, ICRs, and supporting documents

Information Collection

Form for community agency points of contact to verify agency information (monthly)

IC 226035 under ICR 201902-0990-004 · OMB 0990-0458.

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

View Information Collection (IC)

Form for community agency points of contact to verify agency information (monthly)
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-listed Agency POC Information Form DVHF.docx No   Paper Only

Health Health Care Services

 

4 0
   
Individuals or Households
 
   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 48 0 0 0 0 48
Annual IC Time Burden (Hours) 12 0 0 0 0 12
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.