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Federal forms, ICRs, and supporting documents

Information Collection

Program Eligibility Protocol

IC 267123 under ICR 202502-0906-004 · OMB 0906-0098.

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

View Information Collection (IC)

Program Eligibility Protocol
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 1 Program Eligibility Protocol Appendix E_Instrument 1_Informal Contacts 4.18.24.docx Yes Yes Fillable Fileable
Form and Instruction 1 0906-0098 1_Program Eligibility Protocol (Redline) 0906-0098 1_Program Eligibility Protocol.docx Yes Yes Fillable Fileable

Health Health Care Services

 

16 16
   
State, Local, and Tribal Governments
 
   100 %

  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 16 0 0 0 0 16
Annual IC Time Burden (Hours) 16 0 0 0 0 16
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.