Information Collection

Part A Allocation and Expenditures Forms

IC 183271 under ICR 202006-0915-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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 1 Part A Allocations Report 30MAR2017 Final_modification Part A Allocation and Expenditures Forms	Form
Form 2 Part A Expenditures Report 30MAR2017 Final 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: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction		Yes	Yes	Fillable Fileable
Form	1	Yes	Yes	Fillable Fileable
Form	2	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
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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