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Federal forms, ICRs, and supporting documents

Information Collection

Service Provider Feedback Form

IC 201612 under ICR 202601-0930-001 · OMB 0930-0270.

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

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Service Provider Feedback Form
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0930-0270 DTAC-CCP_Service Provider Feedback Form 0930-0270 DTAC-CCP_Service Provider Feedback Form 0930-0270 DTAC-CCPTkit-ProviderSurvey-Final.pdf Yes Yes Fillable Fileable

Health Health Care Services

Service Provider Feedback Form  75 FR 28264

400 0
   
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 400 0 400 0 0 0
Annual IC Time Burden (Hours) 120 0 120 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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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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