Information Collection

Part D Expenditures Report

IC 242479 under ICR 202302-0915-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 D-2 Part D Expenditures Report	Form
D-2 Part D Expenditures Report.docx Part D Expenditures Report.docx	Form
D-2 Part D Expenditures Report.docx Part D Expenditures Report.docx	Form
D-2 Part D COVID-19 Expenditures Part D COVID-19 Expenditures clean copy for OMB.docx	Form
D-2 Part D COVID-19 Expenditures Part D COVID-19 Expenditures clean copy for OMB.docx	Form

IC Title:

Part D Expenditures Report

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-2	Part D Expenditures Report.docx	Part D Expenditures Report.docx		Yes	Yes	Fillable Fileable
Form	D-2	Part D COVID-19 Expenditures	Part D COVID-19 Expenditures 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: 116

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
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-116	116
Annual IC Time Burden (Hours)	-464	464
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.