OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

RETAIN Provider Surveys (R1 & R2)

IC 246357 under ICR 202404-0960-002 · OMB 0960-0821.

Documents and Forms
Document Name
Document Type
Other-RETAIN PROVIDER SURVEY INSTRUM
Other-RETAIN PROVIDER SURVEY INSTRUM
Other-RETAIN PROVIDER SURVEY MAILING
Other-RETAIN PROVIDER SURVEY MAILING
Other-Finalized Survey Questions C15
Other-Finalized Survey Questions C15
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

RETAIN Provider Surveys (R1 & R2)
 
No Removed
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-RETAIN PROVIDER SURVEY INSTRUMENTS (R1, R2) APPENDIX G - PROVIDER SURVEY INSTRUMENTS (R1, R2).pdf No   Paper Only
Other-RETAIN PROVIDER SURVEY MAILINGS (R1, R2) APPENDIX H - PROVIDER SURVEY MAILINGS (R1, R2).pdf No   Paper Only
Other-Finalized Survey Questions C15-C18 Provider Survey - Finalized Quetions (C15 - C18).pdf No   Printable Only

Income Security General Retirement and Disability

 

800 0
   
Individuals or Households
 
   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 0 0 -800 0 0 800
Annual IC Time Burden (Hours) 0 0 -190 0 0 190
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Current Provider Survey Questions (showing placeholders for C15-C18) APPENDIX G - PROVIDER SURVEY INSTRUMENTS (R1, R2) - Current Version.pdf 08/19/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.