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MSA or Medicare+Choice MSA Information
MSA or Medicare+Choice MSA Information
OMB: 1545-1518
IC ID: 40849
OMB.report
TREAS/IRS
OMB 1545-1518
ICR 200403-1545-043
IC 40849
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-1518 can be found here:
2021-12-31 - Extension without change of a currently approved collection
2018-10-30 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
MSA or Medicare+Choice MSA Information
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
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
5498-SA
Yes
Yes
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
16,442
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
95 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
41,105
0
0
0
0
41,105
Annual IC Time Burden (Hours)
6,988
0
0
0
0
6,988
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.