OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Disclosure Request Form

IC 229441 under ICR 202408-0938-032 · OMB 0938-1080.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form CMS-10307
Disclosure Request Form		 Form and Instruction
Form CMS-10307
Model Disclosure Template (English) Disclosure Request Form		 Form and Instruction
Form CMS-10307
Model Disclosure Template (Arabic) Disclosure Request Form		 Form and Instruction
Form CMS-10307
Model Disclosure Template (Korean_ Disclosure Request Form		 Form and Instruction
Form CMS-10307
Model Disclosure Template (Tagalog) Disclosure Request Form		 Form and Instruction
Form CMS-10307
Model Disclosure Template (Spanish) Disclosure Request Form		 Form and Instruction
Form CMS-10307
Model Disclosure Template (Vietnamese) Disclosure Request Form		 Form and Instruction
Form CMS-10307
Model Disclosure Template (Chinese) Disclosure Request Form		 Form and Instruction
Form CMS-10307
Model Disclosure Template (Vietnamese) Disclosure Request Form		 Form and Instruction
Form CMS-10307
Model Disclosure Template (Korean)) Disclosure Request Form		 Form and Instruction
CMS-10307 Model Disclosure Template (English)
CMS-10307_Model_Disclosure_Template_ENGLISH.pdf 		Form and Instruction
CMS-10307 Model Disclosure Template (English)
CMS-10307_Model_Disclosure_Template_ENGLISH.pdf 		Form and Instruction
CMS-10307 Model Disclosure Template (Arabic)
CMS-10307_Model_Disclosure_Template_ARABIC.pdf 		Form and Instruction
CMS-10307 Model Disclosure Template (Arabic)
CMS-10307_Model_Disclosure_Template_ARABIC.pdf 		Form and Instruction
CMS-10307 Model Disclosure Template (Korean_
CMS-10307_Model_Disclosure_Template_FRENCH.pdf 		Form and Instruction
CMS-10307 Model Disclosure Template (Korean_
CMS-10307_Model_Disclosure_Template_FRENCH.pdf 		Form and Instruction
CMS-10307 Model Disclosure Template (Tagalog)
CMS-10307_Model_Disclosure_Template_TAGALOG.pdf 		Form and Instruction
CMS-10307 Model Disclosure Template (Tagalog)
CMS-10307_Model_Disclosure_Template_TAGALOG.pdf 		Form and Instruction
CMS-10307 Model Disclosure Template (Spanish)
CMS-10307_Model_Disclosure_Template_SPANISH.pdf 		Form and Instruction
CMS-10307 Model Disclosure Template (Spanish)
CMS-10307_Model_Disclosure_Template_SPANISH.pdf 		Form and Instruction
CMS-10307 Model Disclosure Template (Vietnamese)
CMS-10307_Model_Disclosure_Template_VIETNAMESE.pdf 		Form and Instruction
CMS-10307 Model Disclosure Template (Vietnamese)
CMS-10307_Model_Disclosure_Template_VIETNAMESE.pdf 		Form and Instruction
CMS-10307 Model Disclosure Template (Chinese)
CMS-10307_Model_Disclosure_Template_TCHINESE.pdf 		Form and Instruction
CMS-10307 Model Disclosure Template (Chinese)
CMS-10307_Model_Disclosure_Template_TCHINESE.pdf 		Form and Instruction
CMS-10307 Model Disclosure Template (Vietnamese)
CMS-10307_Model_Disclosure_Template_VIETNAMESE.pdf 		Form and Instruction
CMS-10307 Model Disclosure Template (Vietnamese)
CMS-10307_Model_Disclosure_Template_VIETNAMESE.pdf 		Form and Instruction
CMS-10307 Model Disclosure Template (Korean))
CMS-10307_Model_Disclosure_Template_KOREAN.pdf 		Form and Instruction
CMS-10307 Model Disclosure Template (Korean))
CMS-10307_Model_Disclosure_Template_KOREAN.pdf 		Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

layout table

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 and Instruction CMS-10307 Yes Yes Fillable Fileable
Form and Instruction CMS-10307 Yes Yes Fillable Fileable
Form and Instruction CMS-10307 Yes Yes Fillable Fileable
Form and Instruction CMS-10307 Yes Yes Fillable Fileable
Form and Instruction CMS-10307 Yes Yes Fillable Fileable
Form and Instruction CMS-10307 Yes Yes Fillable Fileable
Form and Instruction CMS-10307 Yes Yes Fillable Fileable
Form and Instruction CMS-10307 Yes Yes Fillable Fileable
Form and Instruction CMS-10307 Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 191,385 0 0 23,960 0 167,425
Annual IC Time Burden (Hours) 15,949 0 0 1,997 0 13,952
Annual IC Cost Burden (Dollars) 0 0 0 0 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.
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