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

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form CMS-1957 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

Information Collection (IC) Details

View Information Collection (IC)

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-1957	SSO Report of State Buy-in Problems	CMS-1957 Collection Instrument.pdf		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 %

	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

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.