Information Collection

Request for Accelerated Payments Supporting Regulations in 42 CFR, section 412.116 & 413.64

IC 7921 under ICR 200512-0938-001 · OMB 0938-0269.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0269 can be found here:

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Information Collection (IC) Details

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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

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	822	72	750
Annual IC Time Burden (Hours)	411	36	375
Annual IC Cost Burden (Dollars)	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.