SSO Report of State Buy-in Problems

Social Security Office (SSO) Report of State Buy-in Problems (CMS-1957)

Documents and Forms

Document Name Document Type
Form CMS-1957 SSO Report of State Buy-in Problems Form
CMS-1957 SSO Report of State Buy-In Problem CMS-1957-508.pdf Form
CMS-1957 SSO Report of State Buy-In Problem CMS-1957-508.pdf Form

Information Collection (IC) Details

IC Title:	SSO Report of State Buy-in Problems	Agency IC Tracking Number:	CMS-1957

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 407.40

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-1957	SSO Report of State Buy-In Problem	CMS-1957-508.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	1,400	-4,454	5,854
Annual IC Time Burden (Hours)	467	-1,484	1,951
Annual IC Cost Burden (Dollars)	0	0	0

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.