Information Collection

Social Security Office (SSO) Report of State Buy-in Problems

IC 7787 under ICR 200912-0938-004 · OMB 0938-0035.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0035 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-1957 SSO Report of State Buy-in Problems Social Security Office (SSO) Report of State Buy-in Problems	Form
CMS-1957 SSO Report of State Buy-in Problems CMS-1957 Collection Instrument.pdf	Form

IC Title:

Social Security Office (SSO) Report of State Buy-in Problems

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	CMS-1957				Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	5,200	-1,400	6,600
Annual IC Time Burden (Hours)	1,716	-650	2,366
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.

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