Information Collection

MSI Participant Registration Information

IC 206361 under ICR 201304-0938-001 · OMB 0938-1199.

Documents and Forms

Document Name Document Type
Form CMS-10457 MSI Participant Registration Information Form and Instruction
CMS-10457 MSI Participant Registration Information MSI Participant Registration Information 1-8-13.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	MSI Participant Registration Information	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10457	MSI Participant Registration Information	MSI Participant Registration Information 1-8-13.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 150,000	Number of Respondents for Small Entity: 100,000

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 New Statute
Annual Number of Responses for this IC	150,000	150,000
Annual IC Time Burden (Hours)	2,500	2,500
Annual IC Cost Burden (Dollars)	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.