Information Collection

The Fiscal Soundness Reporting Requirements (CMS-906)

IC 8094 under ICR 201904-0938-013 · 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⚠️ Notice: This information collection may be referencing outdated material.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
HPMS_FSM_Plan_User_Guide.pdf	Instruction
HPMS-FSM_PRA Disclosure Statement.pdf	Other-null
CMS-906 Health Plan Management System (HPMS) Collection Instrument and Instructions_OMB 0938-0469.pdf	Form and Instruction

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 516(a)(5) 42 CFR 460.208 42 CFR 423.514 (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	Health Plan Management System (HPMS)	Collection Instrument and Instructions_OMB 0938-0469.pdf	Yes	Yes	Fillable Fileable Signable
Instruction			HPMS_FSM_Plan_User_Guide.pdf	No		Printable Only
Other-null			HPMS-FSM_PRA Disclosure Statement.pdf	Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 767

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

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	1,589	71	1,518
Annual IC Time Burden (Hours)	530	24	506
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.