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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form 1 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

Information Collection (IC) Details

View Information Collection (IC)

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:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Part A Allocations Report 30MAR2017 Final_modification	Part A Allocations Report 30MAR2017 Final_modification sent 7242017.xlsx	Yes	Yes	Fillable Fileable
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

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 %

	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

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.