Information Collection

State Medical Support Contacts and Program Requirement Matrix (State Respondents) - Implementation Year

IC 255976 under ICR 202605-0970-009 · OMB 0970-0222.

Documents and Forms

Document Name Document Type
Form NMSN Matrix State Medical Support Contacts and Program Requirement Matrix State Medical Support Contacts and Program Requirement Matrix (State Respondents) - Implementation Year Form
Form NMSN Matrix State Medical Support Contacts and Program Requirement Matrix State Medical Support Contacts and Program Requirement Matrix (State Respondents) - Implementation Year Form
NMSN Matrix State Medical Support Contacts and Program Requirement M 2022_10_27_NMSN_State_Medical_Support_Contacts_and_Program_Requirements_after 30 Day comments_clean.docx Form
NMSN Matrix State Medical Support Contacts and Program Requirement M 2022_10_27_NMSN_State_Medical_Support_Contacts_and_Program_Requirements_after 30 Day comments_clean.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State Medical Support Contacts and Program Requirement Matrix (State Respondents) - Implementation Year	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	NMSN Matrix	State Medical Support Contacts and Program Requirement Matrix	2022_10_27_NMSN_State_Medical_Support_Contacts_and_Program_Requirements_after 30 Day comments_clean.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 54	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	18	-36	54
Annual IC Time Burden (Hours)	18	-36	54
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.

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