Insurance Match Debt Inquiry Agreement and Profile

Child Support Portal Registration

OMB: 0970-0370

IC ID: 233424

Information Collection (IC) Details

View Information Collection (IC)

Insurance Match Debt Inquiry Agreement and Profile
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Insurance Match Debt Inquiry Agreement and Profile 0970-0370_Insurance_Match_Debt_Inquiry_Agmt_Profile.pdf Yes Yes Fillable Fileable

Community and Social Services Social Services

 

6 0
   
State, Local, and Tribal Governments
 
   100 %

  Requested 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 6 0 -12 0 0 18
Annual IC Time Burden (Hours) 0 0 -1 0 0 1
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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