National Medical Support Notice-Part A (State Respondents)

National Medical Support Notice - Part A

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0222 can be found here:

Documents and Forms

Document Name Document Type
Form Part A - Revised 2 National Medical Support Notice-Part A (State Respondents) Form
2023 02 23 NMSN_Part_A_Sample_Form Clean.docx Instruction
Part A - Revised 2 National Medical Support Notice Part A 2023 02 23 NMSN Part A Clean.docx Form

Information Collection (IC) Details

IC Title:	National Medical Support Notice-Part A (State Respondents)	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	Part A - Revised 2023	National Medical Support Notice Part A	2023 02 23 NMSN Part A Clean.docx		Yes	Yes	Fillable Printable
Instruction			2023 02 23 NMSN_Part_A_Sample_Form Clean.docx		Yes	Yes	Fillable Printable

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	Previously Approved
Annual Number of Responses for this IC	4,870,476	4,870,476
Annual IC Time Burden (Hours)	827,981	827,981
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.