Information Collection

National Medical Support Notice-Part A (State Respondents)

IC 10060 under ICR 201907-0970-003 · OMB 0970-0222.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0222 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Part A National Medical Support Notice-Part A (State Respondents)	Form and Instruction
Part A National Medical Support Notice - Part A OMB_0970_0222_PartA_07012019_Final.docx	Form and Instruction

IC Title:

National Medical Support Notice-Part A (State Respondents)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Part A	National Medical Support Notice - Part A	OMB_0970_0222_PartA_07012019_Final.docx		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 54

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	4,840,236	709,290	4,130,946
Annual IC Time Burden (Hours)	822,840	120,579	702,261
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.