Information Collection Request
Request for Employment Information (CMS-R-297/CMS-L564)
ICR 202305-0938-015 · OMB 0938-0787 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-0787 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-R-297 (CMS-L56 Request for Employment Information |
Form and Instruction | Modified | Missing upstream |
 CMS-R-297 (CMS-L564) - Supporting Statement A_.docx |
Supporting Statement A | Uploaded 2023-05-31 | Repair queued |
 Justification for Collecting SSNs.doc |
Supplementary Document | Uploaded 2014-01-04 | Missing upstream |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 8554 |  Request for Employment Information |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-0787 |
| Type of Information Collection | Extension without change of a currently approved collection |
| Previous ICR Reference No | 202003-0938-014 |
| Agency Tracking No | CM-CPC |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |