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Federal forms, ICRs, and supporting documents

Information Collection

Section 493.801 and 493.803

IC 225802 under ICR 202606-0938-021 · OMB 0938-0612.

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

View Information Collection (IC)

Section 493.801 and 493.803
 
No Unchanged
 
Mandatory
 
42 CFR 493.801 & 493.803

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction SOM Appendix C.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

49,646 0
   
State, Local, and Tribal Governments
 
   0 %

  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 297,876 0 0 0 0 297,876
Annual IC Time Burden (Hours) 446,814 0 0 0 0 446,814
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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