Information Collection

Part A Allocations Report

IC 183271 under ICR 202105-0915-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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 A-1 Part A Allocations Report	Form
A-1 Part A COVID-19 Allocations Part A COVID-19 Allocations clean copy to OMB.docx	Form
A-1 Part A COVID-19 Allocations Part A COVID-19 Allocations clean copy to OMB.docx	Form
A-1 Part A Allocations Report.docx Part A Allocations Report.docx	Form
A-1 Part A Allocations Report.docx Part A Allocations Report.docx	Form

IC Title:

Part A Allocations Report

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	A-1	Part A COVID-19 Allocations	Part A COVID-19 Allocations clean copy to OMB.docx		Yes	Yes	Fillable Fileable
Form	A-1	Part A Allocations Report.docx	Part A Allocations Report.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 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	52	52
Annual IC Time Burden (Hours)	208	208
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.