Individuals Authorized Access to the CMS Computer Services

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Individuals Authorized Access to the CMS Computer Services	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:

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 %

	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

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.