Information Collection

D-SNP Enrollee Advisory Committee (Soliciting Committee Members) (422.107)

IC 251118 under ICR 202506-0938-004 · OMB 0938-1422.

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Information Collection (IC) Details

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IC Title:	D-SNP Enrollee Advisory Committee (Soliciting Committee Members) (422.107)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 422.10(f)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 398	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	398	88	310
Annual IC Time Burden (Hours)	15,920	3,520	12,400
Annual IC Cost Burden (Dollars)	0	0	0

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