Information Collection

155.225(b)(1)(ii) - Issuance of unique registration identification number

IC 208213 under ICR 202210-0938-013 · OMB 0938-1205.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10494 155.225(b)(1)(ii) - Issuance of unique registration identification number	Form and Instruction
CMS-10494 Registration Portal CMS-10494 - Appendix D_Registration Portal.docx	Form and Instruction
CMS-10494 Registration Portal CMS-10494 - Appendix D_Registration Portal.docx	Form and Instruction
CMS-2334-F2-APPENDIX B.PDF Data Elements	IC Document
CMS-2334-F2-APPENDIX B.PDF Data Elements	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 155.225(b)(1)(ii)

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
Form and Instruction	CMS-10494	Registration Portal	CMS-10494 - Appendix D_Registration Portal.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,000

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: 80 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	30,000	30,000
Annual IC Time Burden (Hours)	900	900
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Data Elements	CMS-2334-F2-APPENDIX B.PDF	08/14/2013

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