Information Collection

IRS/SSA/CMS Data Match and Supporting Regulations in 42 CFR Sections 411.20-411.206

IC 8156 under ICR 200510-0938-013 · OMB 0938-0565.

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Information Collection (IC) Details

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IC Title:	IRS/SSA/CMS Data Match and Supporting Regulations in 42 CFR Sections 411.20-411.206	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	CMS-R-137				Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 341,065	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 9 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	341,065	13,118	327,947
Annual IC Time Burden (Hours)	1,986,810	890,344	1,096,466
Annual IC Cost Burden (Dollars)	0	0	0

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