Access and Recertification

CMS Enterprise Identity Management System

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1236 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10452 Access and Recertification Form and Instruction
CMS-10452 CMS Enterprise Identity Management System Sample_EIDM_Mockupv4_508.pptx Form and Instruction

Information Collection (IC) Details

IC Title:	Access and Recertification	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-10452	CMS Enterprise Identity Management System	Sample_EIDM_Mockupv4_508.pptx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 21,666,667	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	21,666,667	21,666,667
Annual IC Time Burden (Hours)	8,666,667	8,666,667
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.