Information Collection Request
Medicare Request for Retirement Benefit Information (CMS-R-285)
ICR 202408-0938-005 · OMB 0938-0769 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-R-285 Request for Retirement Benefit Informatin |
Form | Modified | Repair queued |
 CMS-R-285 - Supporting Statement A_.docx |
Supporting Statement A | Uploaded 2024-08-07 | Missing upstream |
| Response to Comments OMB 0938 0769.docx |
Supplementary Document | Uploaded 2024-08-06 | Repair queued |
 Crosswalk of Changes CMS R285_508.pdf |
Supplementary Document | Uploaded 2024-08-06 | Repair queued |
| Justification - Use of SSN.docx |
Supplementary Document | Uploaded 2013-09-08 | Available |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 8511 |  Request for Retirement Benefit Informatin |
Form | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-0769 |
| Type of Information Collection | Reinstatement with change of a previously approved collection |
| Previous ICR Reference No | 202012-0938-017 |
| Agency Tracking No | CM-CPC |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |