Information Collection

? 422.101 - Update HRA System

IC 258370 under ICR 202302-0938-007 · OMB 0938-1446.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1446 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CMS-10825_HRA SDOH Guidance.docx	Instruction
CMS-10825_HRA SDOH Guidance.docx	Instruction

IC Title:

§ 422.101 - Update HRA System

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 422.101

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
Instruction			CMS-10825_HRA SDOH Guidance.docx		Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 45

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: 100 %

table that charts list of burden
	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	45	45
Annual IC Time Burden (Hours)	135	135
Annual IC Cost Burden (Dollars)	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.