Information Collection

The Fiscal Soundness Reporting Requirements (CMS-906)

IC 8094 under ICR 201004-0938-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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.pdf	Other-screen shot
REV_Fiscal Soundness Reporting Req42210tc.doc	Instruction
Fiscal Soundness Reporting Req track changes.doc Fiscal Soundness Reporting Req track changes	IC Document
Crosswalk_for_CMS_906.pdf Crosswalk_for_CMS_906	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) 42 CFR 423.514 42 CFR 460.208 (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-screen shot			Screen_Shot.pdf		Yes	Yes	Printable Only
Instruction			REV_Fiscal Soundness Reporting Req42210tc.doc		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 514

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	1,039	339	700
Annual IC Time Burden (Hours)	346	113	233
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fiscal Soundness Reporting Req track changes	Fiscal Soundness Reporting Req track changes.doc	03/19/2010
Crosswalk_for_CMS_906	Crosswalk_for_CMS_906.pdf	03/19/2010

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