IRS/SSA/CMS Data Match and Supporting Regulations in 42 CFR Sections 411.20-411.206

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0565 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-R-137 IRS/SSA/CMS Data Match and Supporting Regulations in 42 CFR Sections 411.20-411.206 Form and Instruction
CMS-R-137 Data Match Instructions IRS_SSA_CMS datamatch instructions 2008.pdf Form and Instruction

Information Collection (IC) Details

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IC Title:	IRS/SSA/CMS Data Match and Supporting Regulations in 42 CFR Sections 411.20-411.206	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 411 42 CFR 423.462

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-R-137	Data Match Instructions	IRS_SSA_CMS datamatch instructions 2008.pdf		No	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 326,597	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	326,597	-14,468	341,065
Annual IC Time Burden (Hours)	1,900,795	-86,015	1,986,810
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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