View Information Collection (IC)

View Information Collection (IC)

Quarterly Reports
No Modified
Required to Obtain or Retain Benefits

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability

Health Health Care Services


51 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 204 0 0 -20 0 224
Annual IC Time Burden (Hours) 10,200 0 0 792 0 9,408
Annual IC Cost Burden (Dollars) 503,119 0 0 199,543 0 303,576

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