No Wrong Door System Management Tool-State and Local Level

No Wrong Door System Management Tool

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0985-0062 can be found here:

Documents and Forms

Document Name Document Type
No Wrong Door System Management Tool-State and Local Level Form and Instruction
No Wrong Door Management Data Colleciton and Entry Tool NWD System Management Tool.docx Form and Instruction

Information Collection (IC) Details

IC Title:	No Wrong Door System Management Tool-State and Local Level	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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	NA	No Wrong Door Management Data Colleciton and Entry Tool	NWD System Management Tool.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,052	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	2,104	2,104
Annual IC Time Burden (Hours)	8,080	8,080
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.