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Request for Accelerated Payments Supporting Regulations in 42 CFR, section 412.116 & 413.64
Request for Accelerated Payments Supporting Regulations in 42 CFR, section 412.116 & 413.64
OMB: 0938-0269
IC ID: 7921
OMB.report
HHS/CMS
OMB 0938-0269
ICR 200512-0938-001
IC 7921
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0269 can be found here:
2011-10-24 - Extension without change of a currently approved collection
2008-12-17 - 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:
Request for Accelerated Payments Supporting Regulations in 42 CFR, section 412.116 & 413.64
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
CMS-9042
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
822
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
0 %
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
822
0
0
72
0
750
Annual IC Time Burden (Hours)
411
0
0
36
0
375
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.