Information Collection

The Fiscal Soundness Reporting Requirements (CMS-906)

IC 8094 under ICR 201602-0938-006 · 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⚠️ Notice: This information collection may be referencing outdated material.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
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
CMS-906 Fiscal Soundness Reporting Requirements Fiscal Soundness Reporting Requirements- Submission Page Word.pdf	Form

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	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
Form	CMS-906	Fiscal Soundness Reporting Requirements	Fiscal Soundness Reporting Requirements- Submission Page Word.pdf	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 815

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	1,518	237	1,281
Annual IC Time Burden (Hours)	506	78	428
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.