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Checklist for Form 5A Scope Adjustments

IC 279987 under ICR 202603-0915-004 · OMB 0915-0285.

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Form and Instruction
Form and Instruction
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Checklist for Form 5A Scope Adjustments
 
No New
 
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 51 2026 Checklist for Form 5A Scope Adjustments 2026 51. Checklist for Form 5A Scope Adjustments.docx Yes Yes Fillable Fileable

Health Health Care Services

 

1,875 0
   
Private Sector Not-for-profit institutions
 
   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 1,875 0 1,875 0 0 0
Annual IC Time Burden (Hours) 938 0 938 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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