Information Collection

Designation, Planning, and Preparation

IC 219565 under ICR 202005-0906-001 · OMB 0906-0029.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0906-0029 can be found here:

Documents and Forms

Document Name Document Type
Form E Designation, Planning, and Preparation Form and Instruction
E PCO Provider Management User Guide - Attachment E.pdf PCO Provider Management User Guide - Attachment E.pdf Form and Instruction
F PCO Designation Management User Guide - Attachment F.pdf PCO Designation Management User Guide - Attachment F.pdf Form and Instruction
G Manual for Policies and Procedures - Attachment G.pdf Manual for Policies and Procedures - Attachment G.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Designation, Planning, and Preparation	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	E	PCO Provider Management User Guide - Attachment E.pdf	PCO Provider Management User Guide - Attachment E.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	F	PCO Designation Management User Guide - Attachment F.pdf	PCO Designation Management User Guide - Attachment F.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	G	Manual for Policies and Procedures - Attachment G.pdf	Manual for Policies and Procedures - Attachment G.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care 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 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,592	-486	3,078
Annual IC Time Burden (Hours)	20,736	-86,163	106,899
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.