DATA 2000 Waiver Training Payment Program Application for Payment

Documents and Forms

Document Name Document Type
Form 1 DATA 2000 Waiver Training Payment Program Application for Payment Form and Instruction
1 SUPPORT Act_Application_final.docx SUPPORT Act_Application_final.docx Form and Instruction
1 SUPPORT Act_Application_final.docx SUPPORT Act_Application_final.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	DATA 2000 Waiver Training Payment Program Application for Payment	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	1	SUPPORT Act_Application_final.docx	SUPPORT Act_Application_final.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	Number of Respondents for Small Entity: 252

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	300	-2,116	2,416
Annual IC Time Burden (Hours)	150	-1,058	1,208
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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