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Federal forms, ICRs, and supporting documents

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Apllication Waiver/ Supplemental B Clinical Care

IC 46706 under ICR 202307-0990-001 · OMB 0990-0001.

Documents and Forms
Document Name
Document Type
Form
Form
Form
Form
Form
Information Collection (IC) Details

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Apllication Waiver/ Supplemental B Clinical Care
 
No Modified
 
Voluntary
 
45 CFR 50.CFR

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 426 Application 0990-0001waiver application.doc No No Paper Only
Form 426 Application 0990-0001_waiver-supplementary_A info.doc No No Paper Only

Health Health Care Services

 

35 0
   
Private Sector Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 35 0 0 0 35 0
Annual IC Time Burden (Hours) 350 0 0 0 350 0
Annual IC Cost Burden (Dollars) 0 0 -43,750 0 43,750 0

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