Information Collection

Part A Allocation and Expenditures Forms

IC 183271 under ICR 201909-0915-004 · OMB 0915-0318.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0318 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Part A Allocation and Expenditures Forms	Form
Part A Allocations Report - instructions.docx	Instruction
1 Part A Allocations Report 30MAR2017 Final_modification Part A Allocations Report 30MAR2017 Final_modification sent 7242017.xlsx	Form
2 Part A Expenditures Report 30MAR2017 Final Part A Expenditures Report 30MAR2017 Final_modified 7242017.xlsx	Form

IC Title:

Part A Allocation and Expenditures Forms

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	2	Part A Expenditures Report 30MAR2017 Final	Part A Expenditures Report 30MAR2017 Final_modified 7242017.xlsx	Yes	Yes	Fillable Fileable
Instruction			Part A Allocations Report - instructions.docx	Yes	Yes	Fillable Fileable
Form	1	Part A Allocations Report 30MAR2017 Final_modification	Part A Allocations Report 30MAR2017 Final_modification sent 7242017.xlsx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 52

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	Previously Approved
Annual Number of Responses for this IC	104	104
Annual IC Time Burden (Hours)	312	312
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.