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Federal forms, ICRs, and supporting documents

Information Collection

Request For Eligibility Reconsideration

IC 160245 under ICR 199301-3245-004 · OMB 3245-0143.

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REQUEST FOR ELIGIBILITY RECONSIDERATION
 
No Migrated
 
Required to Obtain or Retain Benefits
 

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


    

600 0
   
Individuals or Households
 
   0 %

  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 600 0 0 0 0 600
Annual IC Time Burden (Hours) 2,400 0 0 0 0 2,400
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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