Information Collection

Participant Information Form (PIF)

IC 221598 under ICR 202206-0915-001 · OMB 0915-0281.

Documents and Forms

Document Name Document Type
Form D Participant Information Form (PIF) Form
D Participation Information Form 218 D_Participation Information Form 2018_Final.pdf Form
D Participation Information Form 218 D_Participation Information Form 2018_Final.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Participant Information Form (PIF)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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	D	Participation Information Form 218	D_Participation Information Form 2018_Final.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 61,288	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-61,288	61,288
Annual IC Time Burden (Hours)	-3,064	3,064
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.