Information Collection Request

National Medical Support Notice - Part A

ICR 202401-0970-001 · OMB 0970-0222 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form Part A - Revised 2 National Medical Support Notice Part A Form New Available
Form Part A - Revised 2 National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (Employer Respondents) Form New Repair queued
Form Part A - Revised 2 National Medical Support Notice Part A Form New Repair queued
Form Part A - Revised 2 National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (State Respondents) Form New Repair queued
Form NMSN Matrix State Medical Support Contacts and Program Requirement Matrix Form Unchanged Available
Form NMSN Matrix State Medical Support Contacts and Program Requirement Matrix (State Respondents) Form Unchanged Repair queued
Form Part A - Revised 2 National Medical Support Notice Part A Form Unchanged Available
Form Part A - Revised 2 National Medical Support Notice-Part A (Employer Respondents) Form Unchanged Repair queued
Form Part A - Revised 2 National Medical Support Notice Part A Form Unchanged Available
Form Part A - Revised 2 National Medical Support Notice-Part A (State Respondents) Form Unchanged Repair queued
2023 e-NMSN record specifications-NMSN Part A_NonSub Change Request_1.2.24.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-01-02 Available
2023 e-NMSN record specifications-NMSN Part A_NonSub Change Request_1.2.24.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-01-02 Repair queued
NMSN Part A _NonSub Change Request_nc_3-2-23.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-03-02 Repair queued
NMSN Part A _NonSub Change Request_nc_3-2-23.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-03-02 Repair queued
NonSub Change Request - MNSN Updates 0970-0222.docx Justification for No Material/Nonsubstantive Change Uploaded 2022-11-23 Available
NonSub Change Request - MNSN Updates 0970-0222.docx Justification for No Material/Nonsubstantive Change Uploaded 2022-11-23 Repair queued
2022 10 27 Public Comments Received on the National Medical Support Notice Part A after 30 day comment period Responses Final for NC.docx Supplementary Document Uploaded 2022-11-23 Available
2022 10 27 Public Comments Received on the National Medical Support Notice Part A after 30 day comment period Responses Final for NC.docx Supplementary Document Uploaded 2022-11-23 Repair queued
Attachment A - Public Comments Received on the National Medical Support Notice Part A_final.docx Supplementary Document Uploaded 2022-09-16 Available
Attachment A - Public Comments Received on the National Medical Support Notice Part A_final.docx Supplementary Document Uploaded 2022-09-16 Repair queued
2022 10 27 NMSN_Part_A_Sample_Form_after 30 day comment period clean Final to NC.docx Supplementary Document Uploaded 2022-11-23 Available
2022 10 27 NMSN_Part_A_Sample_Form_after 30 day comment period clean Final to NC.docx Supplementary Document Uploaded 2022-11-23 Repair queued
NMSN Part A Supporting Statement _NonSub Chg - eNMSN_1.2.24.docx Supporting Statement A Uploaded 2024-01-02 Available
NMSN Part A Supporting Statement _NonSub Chg - eNMSN_1.2.24.docx Supporting Statement A Uploaded 2024-01-02 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
264137 National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (Employer Respondents) Form NewNational Medical Support Notice Part A
264137 National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (Employer Respondents) Form New
264137 National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (Employer Respondents) Instruction New
264134 National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (State Respondents) Form NewNational Medical Support Notice Part A
264134 National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (State Respondents) Form New
264134 National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (State Respondents) Instruction New
255976 State Medical Support Contacts and Program Requirement Matrix (State Respondents) Form UnchangedState Medical Support Contacts and Program Requirement Matrix
255976 State Medical Support Contacts and Program Requirement Matrix (State Respondents) Form Unchanged
236881 National Medical Support Notice-Part A (Employer Respondents) Form UnchangedNational Medical Support Notice Part A
236881 National Medical Support Notice-Part A (Employer Respondents) Form Unchanged
236881 National Medical Support Notice-Part A (Employer Respondents) Instruction Unchanged
10060 National Medical Support Notice-Part A (State Respondents) Form UnchangedNational Medical Support Notice Part A
10060 National Medical Support Notice-Part A (State Respondents) Form Unchanged
10060 National Medical Support Notice-Part A (State Respondents) Instruction Unchanged

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
11/30/2025 11/30/2025 11/30/2025
9,771,527 0 9,746,434
1,657,190 0 1,656,939
0 0 0





Reginfo record details
5
table that charts list of burden
IC Title Form No. Form Name
National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (Employer Respondents) Part A - Revised 2023
National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (State Respondents) Part A - Revised 2023
National Medical Support Notice-Part A (Employer Respondents) Part A - Revised 2023
National Medical Support Notice-Part A (State Respondents) Part A - Revised 2023
State Medical Support Contacts and Program Requirement Matrix (State Respondents) NMSN Matrix

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 9,771,527 9,746,434 0 25,093 0 0
Annual Time Burden (Hours) 1,657,190 1,656,939 0 251 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No