Information Collection

DATA 2000 Waiver Training Payment Program Application for Payment

IC 244948 under ICR 202402-0906-002 · OMB 0906-0061.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 DATA 2000 Waiver Training Payment Program Application for Payment	Form and Instruction
1 SUPPORT Act_Application_final.docx SUPPORT Act_Application_final.docx	Form and Instruction
1 SUPPORT Act_Application_final.docx SUPPORT Act_Application_final.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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 and Instruction	1	SUPPORT Act_Application_final.docx	SUPPORT Act_Application_final.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

Number of Respondents for Small Entity: 252

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	300	-2,116	2,416
Annual IC Time Burden (Hours)	150	-1,058	1,208
Annual IC Cost Burden (Dollars)	0	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.