OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Integrated HRAs (minimal work)

IC 273854 under ICR 202501-0938-013 · OMB 0938-1446.

Documents and Forms
Document Name
Document Type
Instruction
Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Integrated HRAs (minimal work)
 
No New
 
Mandatory
 
42 CFR 422.101(f)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction CMS-10825_HRA SDOH Guidance (CMS-4208-P version 2).docx Yes No Printable Only

Health Health Care Services

 

13 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Requested 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 13 0 13 0 0 0
Annual IC Time Burden (Hours) 26 0 26 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
REDLINE: Appendix A - List of Screening Instruments CMS-10825_HRA SDOH Guidance (CMS-4208-P version 2) REDLINE.pdf 01/27/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.