Information Collection

AM (Record Retention)

IC 211454 under ICR 202511-0938-012 · OMB 0938-1237.

Documents and Forms

Document Name Document Type
CMS-10495 - Record Retention Requirements 9.23.2020 - 508 cf.pdf Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	AM (Record Retention)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 403.912(e)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			CMS-10495 - Record Retention Requirements 9.23.2020 - 508 cf.pdf		No		Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,768	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,768	179	1,589
Annual IC Time Burden (Hours)	1,768	179	1,589
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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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