View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

[OC] DCPC Screen for Life 0920-0572-24IO
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0572 N/A Yes Yes Fillable Fileable
Form and Instruction 0920-0572 N/A Yes Yes Fillable Fileable
Form and Instruction 0920-0572 N/A No   Paper Only
Form and Instruction 0920-0572 N/A Yes Yes Fillable Fileable
Form and Instruction 0920-0572 N/A No   Paper Only
Form and Instruction 0920-0572 N/A Yes Yes Fillable Fileable
Form and Instruction 0920--0572 N/A Yes Yes Fillable Fileable
Form and Instruction 0920-0572 N/A Yes Yes Fillable Fileable
Form and Instruction 0920-0572 N/A No   Paper Only
Form and Instruction 0920-0572 N/A Yes Yes Fillable Fileable
Form and Instruction 0920-0572 N/A No   Paper Only
Form and Instruction 0920-0572 N/A Yes Yes Fillable Fileable

Health Illness Prevention

 

1,050 0
   
Individuals or Households
 
   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 1,050 0 1,050 0 0 0
Annual IC Time Burden (Hours) 105 0 105 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
List of Attachments 09/03/2024
Background Information 09/03/2024
DCPC Messages to be Tested 09/03/2024
GenIC Request Memo - HMTS Expedited Review Form 09/03/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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