Information Collection

The Fiscal Soundness Reporting Requirements (CMS-906)

IC 8094 under ICR 200806-0938-006 · OMB 0938-0469.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0469 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Screen Shot.doc	Other-Sreen Shot (CMS-906)
FSRR Dictionary.doc FSRR Dictionary	IC Document
HPMS_FSRRElements.XLS HPMS_FSRRElements	IC Document

IC Title:

The Fiscal Soundness Reporting Requirements (CMS-906)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 516(a)(5) (To search for a specific CFR, visit the Code of Federal Regulations.)

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-Sreen Shot (CMS-906)			Screen Shot.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 700

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	700	330	370
Annual IC Time Burden (Hours)	233	171	62
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
FSRR Dictionary	FSRR Dictionary.doc	06/16/2008
HPMS_FSRRElements	HPMS_FSRRElements.XLS	06/16/2008

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