Information Collection

Access and Recertification

IC 208567 under ICR 201911-0938-010 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
CMS IDM MFA Device Mockup_508.docx	Other-Screen Shot
CMS IDM User Account Registration Mockup_508.docx	Other-Screen Shot

IC Title:

Access and Recertification

Agency IC Tracking Number:

OIT

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screen Shot			CMS IDM MFA Device Mockup_508.docx		Yes	Yes	Fillable Fileable Signable
Other-Screen Shot			CMS IDM 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: 560,000

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	Previously Approved
Annual Number of Responses for this IC	560,000	-190,000	750,000
Annual IC Time Burden (Hours)	186,667	-113,333	300,000
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.