Information Collection

Participant Information Form (PIF)

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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

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:

table that charts list of 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 %

table that charts list of burden
	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

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.