Information Collection

Mapping and Questionnaire Documents IA 30628 A4 (CMS)

IC 234986 under ICR 201805-1090-003 · OMB 1090-0008.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1090-0008 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 30628 Mapping and Questionnaire Documents IA 30628 A4 (CMS)	Form and Instruction
30628 Q_CGSDMEB_Web_Browse_20180907_DOT Q_CGSDMEB_Web_Browse_20180907_DOT.xlsx	Form and Instruction
30628 Q_CGSDMEC_Web_Browse_20180907_DOT Q_CGSDMEB_Web_Browse_20180907_DOT.xlsx	Form and Instruction
30628 Q_CGSJ15_Web_Browse_20180907_DOT Q_CGSJ15_Web_Browse_20180907_DOT.xlsx	Form and Instruction
30628 Q_CMS-FCSO_Web_Browse_20170214 Q_CMS-FCSO_Web_Browse_20170214.xlsx	Form and Instruction
30628 Q_NGSJ6_Web_Browse_20180618_DOT Q_NGSJ6_Web_Browse_20180618_DOT.xlsx	Form and Instruction
30628 Q_NGSJK_Web_Browse_20180618_DOT Q_NGSJK_Web_Browse_20180618_DOT.xlsx	Form and Instruction
30628 Q_NordDmeJa_Web_Browse_20161227 Q_NordDmeJa_Web_Browse_20161227.xlsx	Form and Instruction
30628 Q_NordJE_Web_Browse_20180418_DOT Q_NordJE_Web_Browse_20180418_DOT.xlsx	Form and Instruction
30628 Q_NordJf_Web_Browse_20161227 Q_NordJf_Web_Browse_20161227.xlsx	Form and Instruction
30628 Q_Novitas-JH_Web_Browse_20170221_DOT Q_Novitas-JH_Web_Browse_20170221_DOT.xlsx	Form and Instruction
30628 Q_Novitas-JL_Web_Browse_20180124_DOT Q_Novitas-JL_Web_Browse_20180124_DOT.xlsx	Form and Instruction
30628 Q_PalmettoGBA_JJ_Web_Browse_20180108_DOT Q_PalmettoGBA_JJ_Web_Browse_20180108_DOT.xlsx	Form and Instruction
30628 Q_PalmettoGBA_Web_Browse_20170329 Q_PalmettoGBA_Web_Browse_20170329.xlsx	Form and Instruction
30628 Q_WPSJ5_Web_Browse_20180202_DOT Q_WPSJ5_Web_Browse_20180202_DOT.xlsx	Form and Instruction
30628 Q_WPSJ5_Web_Browse_20180202_DOT Q_WPSJ8_Web_Browse_20180212_DOT.xlsx	Form and Instruction
1090-0008 Generic Clearance Request Form_CMS Survey_IA 30628 Amend 4.pdf 1090-0008 Generic Clearance Request Form_CMS Survey_IA 30628 Amend 4	IC Document
OMB Mapping 2018-2019 Survey (CMS) IA 30628 Amend 4.xlsx OMB Mapping 2018-2019 Survey (CMS) IA 30628 Amend 4	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Mapping and Questionnaire Documents IA 30628 A4 (CMS)

Agency IC Tracking Number:

30628 M4

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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	30628	Q_CGSDMEB_Web_Browse_20180907_DOT	Q_CGSDMEB_Web_Browse_20180907_DOT.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	30628	Q_CGSDMEC_Web_Browse_20180907_DOT	Q_CGSDMEB_Web_Browse_20180907_DOT.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	30628	Q_CGSJ15_Web_Browse_20180907_DOT	Q_CGSJ15_Web_Browse_20180907_DOT.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	30628	Q_CMS-FCSO_Web_Browse_20170214	Q_CMS-FCSO_Web_Browse_20170214.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	30628	Q_NGSJ6_Web_Browse_20180618_DOT	Q_NGSJ6_Web_Browse_20180618_DOT.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	30628	Q_NGSJK_Web_Browse_20180618_DOT	Q_NGSJK_Web_Browse_20180618_DOT.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	30628	Q_NordDmeJa_Web_Browse_20161227	Q_NordDmeJa_Web_Browse_20161227.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	30628	Q_NordJE_Web_Browse_20180418_DOT	Q_NordJE_Web_Browse_20180418_DOT.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	30628	Q_NordJf_Web_Browse_20161227	Q_NordJf_Web_Browse_20161227.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	30628	Q_Novitas-JH_Web_Browse_20170221_DOT	Q_Novitas-JH_Web_Browse_20170221_DOT.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	30628	Q_Novitas-JL_Web_Browse_20180124_DOT	Q_Novitas-JL_Web_Browse_20180124_DOT.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	30628	Q_PalmettoGBA_JJ_Web_Browse_20180108_DOT	Q_PalmettoGBA_JJ_Web_Browse_20180108_DOT.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	30628	Q_PalmettoGBA_Web_Browse_20170329	Q_PalmettoGBA_Web_Browse_20170329.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	30628	Q_WPSJ5_Web_Browse_20180202_DOT	Q_WPSJ5_Web_Browse_20180202_DOT.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	30628	Q_WPSJ5_Web_Browse_20180202_DOT	Q_WPSJ8_Web_Browse_20180212_DOT.xlsx	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,600

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,600	3,600
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
1090-0008 Generic Clearance Request Form_CMS Survey_IA 30628 Amend 4	1090-0008 Generic Clearance Request Form_CMS Survey_IA 30628 Amend 4.pdf	02/19/2019
OMB Mapping 2018-2019 Survey (CMS) IA 30628 Amend 4	OMB Mapping 2018-2019 Survey (CMS) IA 30628 Amend 4.xlsx	02/19/2019

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.