Information Collection

National Medical Support Notice-Part A (Employer Respondents)

IC 236881 under ICR 202401-0970-001 · OMB 0970-0222.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0222 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Part A - Revised 2 National Medical Support Notice-Part A (Employer Respondents)	Form
Form Part A - Revised 2 National Medical Support Notice-Part A (Employer Respondents)	Form
2023 02 23 NMSN_Part_A_Sample_Form Clean.docx	Instruction
2023 02 23 NMSN_Part_A_Sample_Form Clean.docx	Instruction
Part A - Revised 2 National Medical Support Notice Part A 2023 02 23 NMSN Part A Clean.docx	Form
Part A - Revised 2 National Medical Support Notice Part A 2023 02 23 NMSN Part A Clean.docx	Form

IC Title:

National Medical Support Notice-Part A (Employer Respondents)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation:

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	Part A - Revised 2023	National Medical Support Notice Part A	2023 02 23 NMSN Part A Clean.docx		Yes	Yes	Fillable Printable
Instruction			2023 02 23 NMSN_Part_A_Sample_Form Clean.docx		Yes	Yes	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,310,727

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	4,875,904	4,875,904
Annual IC Time Burden (Hours)	828,904	828,904
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.