Voucher Tool

Access to Recovery (ATR) Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0266 can be found here:

Documents and Forms

Document Name Document Type
Form Voucher Informatio Voucher Tool Form and Instruction
Voucher Informatio Voucher Information and Transaction Attachment A Voucher Information and Transaction.doc Form and Instruction

Information Collection (IC) Details

IC Title:	Voucher Tool	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Voucher Information and Transaction	Voucher Information and Transaction	Attachment A Voucher Information and Transaction.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 53,333	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	80,000	-506,666	586,666
Annual IC Time Burden (Hours)	2,400	-79,227	81,627
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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