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

View Information Collection (IC)

State Health Insurance Assistance Program (SHIP) Client Contact Form, Public and Media Activity Form, and Resource Report
 
No Migrated
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form C Yes Yes
Form B Yes Yes
Form CMS-10028A Yes Yes


    

12,000 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 1,000,000 0 0 999,735 0 265
Annual IC Time Burden (Hours) 116,747 0 0 116,588 0 159
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
 
 
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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