Information Collection

Core VIPP Non-Funded SHD: SOTS Financial Module

IC 200347 under ICR 201401-0920-005 · OMB 0920-0916.

Documents and Forms

Document Name Document Type
Form 4 Core VIPP Non-Funded SHD: SOTS Financial Module Form and Instruction
4 Core VIPP Non-Funded SHD: SOTS Financial Module Attachment E-2 - WORD.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Core VIPP Non-Funded SHD: SOTS Financial Module	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

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 and Instruction	4	Core VIPP Non-Funded SHD: SOTS Financial Module	Attachment E-2 - WORD.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 22	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-22	22
Annual IC Time Burden (Hours)	-22	22
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.