The Fiscal Soundness Reporting Requirements (CMS-906)

The Fiscal Soundness Reporting Requirements

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0469 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-906 The Fiscal Soundness Reporting Requirements (CMS-906) Form and Instruction
CMS-906 Fiscal Soundness-Submission of Financial information pag Fiscal Soundness-Submission of Financial information page-PRA.docx Form and Instruction
CMS-906 Submission_page CMS-906_Fiscal_Soundness_Reporting_Requirements_Submission_page.pdf Form and Instruction

Information Collection (IC) Details

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 423.514 42 CFR 516(a)(5) 42 CFR 460.208 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-906	Fiscal Soundness-Submission of Financial information page-PRA	Fiscal Soundness-Submission of Financial information page-PRA.docx		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-906	Submission_page	CMS-906_Fiscal_Soundness_Reporting_Requirements_Submission_page.pdf		No	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 648	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,281	242	1,039
Annual IC Time Burden (Hours)	428	82	346
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.