Request for Employment Information

Request for Employment Information (CMS-R-297/CMS-L564)

OMB: 0938-0787

IC ID: 8554

Information Collection (IC) Details

View Information Collection (IC)

Request for Employment Information
 
No Modified
 
Voluntary
 
42 CFR 407.18 42 CFR 407.17 42 CFR 407.20

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-R-297 (CMS-L564) Request for Employment Information CMS-L564_508.pdf Yes No Fillable Printable
Form and Instruction CMS-R-297 (CMS-L564) SP Solicitud De Informaciaon Sobre El Empleo CMS-L564S.pdf Yes No Fillable Printable

Health Health Care Services

 

15,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 15,000 0 0 0 15,000 0
Annual IC Time Burden (Hours) 5,000 0 0 0 5,000 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.

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