Staff for Enrollment Data Collection

CHIPRA-Children's Health Insurance Program Reauthorization Act of 2009 -ELE

Documents and Forms

Document Name Document Type
3. REVISED ATTACHMENT C ENROLLMENT EXTRACTION FORM IN EXCEL.xlsx Other-REVISED ATTACHMENT C ENROLLMEN

Information Collection (IC) Details

IC Title:	Staff for Enrollment Data Collection	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Other-REVISED ATTACHMENT C ENROLLMENT EXTRACTION FORM IN EXCEL			3. REVISED ATTACHMENT C ENROLLMENT EXTRACTION FORM IN EXCEL.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6	6
Annual IC Time Burden (Hours)	240	240
Annual IC Cost Burden (Dollars)	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.