Information Collection

Part C Allocations Report

IC 183275 under ICR 202006-0915-006 · 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⚠️ Notice: This information collection may be referencing outdated material.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 C-1 Part C Allocations Report Form
C-1 Part C Allocations Report.docx Part C Allocations Report.docx Form
C-1 Part C COVID-19 Allocations Part C COVID-19 Allocations clean copy for OMB.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Part C Allocations Report	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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	C-1	Part C Allocations Report.docx	Part C Allocations Report.docx		Yes	Yes	Fillable Fileable
Form	C-1	Part C COVID-19 Allocations	Part C COVID-19 Allocations clean copy for OMB.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 346	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	346	-346	692
Annual IC Time Burden (Hours)	1,384	0	1,384
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.