Information Collection

Individuals Authorized Access to the CMS Computer Services

IC 8851 under ICR 200710-0938-006 · OMB 0938-0989.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10173 Individuals Authorized Access to the CMS Computer Services	Form and Instruction
CMS-10173 IACS Registration Screen IACS Registration Screen.doc	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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
Form and Instruction	CMS-10173	IACS Registration Screen	IACS Registration Screen.doc		Yes	No	Fillable Fileable Signable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,000,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	4,000,000	-56,000,000	60,000,000
Annual IC Time Burden (Hours)	668,000	-14,332,000	15,000,000
Annual IC Cost Burden (Dollars)	0	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.