Information Collection

State Plan preprints to Implement Sections of the Deficit Reduction Act of 2006 and Third-party Disclosure for Non-emergencies

IC 180500 under ICR 200706-0938-001 · OMB 0938-0993.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0993 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
6043SMD(3) (2).doc	Other-6043 SMD
CMS-10190 6043 Cost Sharing Preprint 6043CostsharingPreprint4 25 2006.doc	Form

IC Title:

State Plan preprints to Implement Sections of the Deficit Reduction Act of 2006 and Third-party Disclosure for Non-emergencies

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-6043 SMD			6043SMD(3) (2).doc		No	No	Paper Only
Form	CMS-10190	6043 Cost Sharing Preprint	6043CostsharingPreprint4 25 2006.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,000	4,000
Annual IC Time Burden (Hours)	667	667
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.