Information Collection

MSA or Medicare+Choice MSA Information

IC 40849 under ICR 200403-1545-043 · OMB 1545-1518.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-1518 can be found here:

Documents and Forms

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Information Collection (IC) Details

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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

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	Previously Approved
Annual Number of Responses for this IC	41,105	41,105
Annual IC Time Burden (Hours)	6,988	6,988
Annual IC Cost Burden (Dollars)	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.