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View Information Collection (IC)

View Information Collection (IC)

GenIC #35 Revised (Eligibility and Enrollment Performance Indicators)
 
New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Performance Indicators Data Dictionary No   Printable Only
Form and Instruction GenIC #35 Yes Yes Fillable Fileable

Health Health Care Services

 

51 0
   
State, Local, and Tribal Governments
 
   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 2,324 0 2,324 0 0 0
Annual IC Time Burden (Hours) 11,352 0 11,352 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Generic Supporting Statement 07/28/2026
Redline - Performance Indicators Data Dictionary 07/28/2026
Crosswalk - All Data Elements 07/28/2026
Crosswalk - New Data Elements 07/28/2026
Mock Up - State Data Information System (SDIS) Tool 07/28/2026
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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