Information Collection

Access and Recertification

IC 208567 under ICR 201708-0938-003 · OMB 0938-1236.

⚠️ Notice: This information collection may be referencing outdated material.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
CMS EIDM MFA Device Mockup_508.docx Other-Screen Shot
CMS EIDM User Account Registration Mockup_508.docx Other-Screen shot

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Access and Recertification	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Other-Screen Shot			CMS EIDM MFA Device Mockup_508.docx		Yes	Yes	Fillable Fileable Signable
Other-Screen shot			CMS EIDM User Account Registration Mockup_508.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 750,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	750,000	-20,916,667	21,666,667
Annual IC Time Burden (Hours)	300,000	-8,366,667	8,666,667
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.