Information Collection

Multi-Language Insert

IC 251079 under ICR 202201-0938-007 · OMB 0938-1421.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1421 can be found here:

Documents and Forms

Document Name Document Type
Attachment A-MLI (CMS-4192-P version 1).pdf Other-Multi-Language Insert (MLI)
Attachment A-MLI (CMS-4192-P version 1).pdf Other-Multi-Language Insert (MLI)

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Multi-Language Insert	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Multi-Language Insert (MLI)			Attachment A-MLI (CMS-4192-P version 1).pdf		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 916	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: 20 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20,800,000	20,800,000
Annual IC Time Burden (Hours)	0	0
Annual IC Cost Burden (Dollars)	312,000	312,000

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.