A Scan of the Status of States' Integration of Human Services and Health Insurance Programs

ASPE Generic Clearance for the Collection of Qualitative Research and Assessment

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0421 can be found here:

Documents and Forms

Document Name Document Type
0990-0421Attachment A_Questionnaire and Instructions_state integration 3_14_16.docx Other-survey
0990-0421 SS_A_ASPE Generic_state integration 3_14_16.docx A Scan of the Status of States’ Integration of Human Services and Health Insurance Programs IC Document
0990-0421SS_B_ASPE Generic_state integration 3_14_16.docx A Scan of the Status of States’ Integration of Human Services and Health Insurance Programs IC Document
0990-0421Cover Sheet_ASPE Generic_state integration 3_14_16.docx A Scan of the Status of States’ Integration of Human Services and Health Insurance Programs IC Document
0990-0421Attachment C_email with link to respondents_state integration 3_14_16.docx EMAIL_A Scan of the Status of States’ Integration of Human Services and Health Insurance Programs IC Document
0990-0421Attachment B_letter to respondents_state integration 3_14_16.docx A Scan of the Status of States’ Integration of Human Services and Health Insurance Programs IC Document
0990-0421Attachment D_APHSA letter to respondents_state integration 3_14_16.docx A Scan of the Status of States’ Integration of Human Services and Health Insurance Programs IC Document

Information Collection (IC) Details

IC Title:	A Scan of the Status of States' Integration of Human Services and Health Insurance Programs	Agency IC Tracking Number:

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-survey			0990-0421Attachment A_Questionnaire and Instructions_state integration 3_14_16.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 92	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
Annual Number of Responses for this IC	46	46
Annual IC Time Burden (Hours)	35	35
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
A Scan of the Status of States’ Integration of Human Services and Health Insurance Programs	0990-0421 SS_A_ASPE Generic_state integration 3_14_16.docx	03/14/2016
A Scan of the Status of States’ Integration of Human Services and Health Insurance Programs	0990-0421SS_B_ASPE Generic_state integration 3_14_16.docx	03/14/2016
A Scan of the Status of States’ Integration of Human Services and Health Insurance Programs	0990-0421Cover Sheet_ASPE Generic_state integration 3_14_16.docx	03/14/2016
EMAIL_A Scan of the Status of States’ Integration of Human Services and Health Insurance Programs	0990-0421Attachment C_email with link to respondents_state integration 3_14_16.docx	03/14/2016
A Scan of the Status of States’ Integration of Human Services and Health Insurance Programs	0990-0421Attachment B_letter to respondents_state integration 3_14_16.docx	03/14/2016
A Scan of the Status of States’ Integration of Human Services and Health Insurance Programs	0990-0421Attachment D_APHSA letter to respondents_state integration 3_14_16.docx	03/14/2016

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