Information Collection

CROWNWeb Authentication Service (CAS) Account Form (First Year)

IC 186126 under ICR 200903-0938-004 · OMB 0938-1050.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1050 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10267 CROWNWeb Authentication Service (CAS) Account Form (First Year)	Form and Instruction
CMS-10267 CAS Account Form CMS-10267.CAS Account Form.pdf	Form and Instruction

IC Title:

CROWNWeb Authentication Service (CAS) Account Form (First Year)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Form and Instruction	CMS-10267	CAS Account Form	CMS-10267.CAS Account Form.pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 13,000

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	Previously Approved
Annual Number of Responses for this IC	13,000	13,000
Annual IC Time Burden (Hours)	6,500	6,500
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.