National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (State Respondents)

National Medical Support Notice - Part A

OMB: 0970-0222

IC ID: 264134

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Information Collection (IC) Details

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National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (State Respondents)
 
No New
 
Mandatory
 

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
Instruction 2023_08_23_e-NMSN_Software_Interface_Specification_Main_Body_V1_6_DRAFT.docx Yes Yes Printable Only
Instruction 2023_08_23_e-NMSN_Software_Interface_Specification_Appendix_A_V1_6_DRAFT.docx Yes Yes Printable Only
Instruction 2023_08_23_e-NMSN_Software_Interface_Specification_Appendix_B_V1_6_DRAFT.docx Yes Yes Printable Only
Instruction 2023_08_23_e-NMSN_Software_Interface_Specification_Appendix_C_V1_6_DRAFT.docx Yes Yes Printable Only
Instruction 2023_08_23_e-NMSN_Software_Interface_Specification_Appendix_D_V1_6_DRAFT.docx Yes Yes Fillable Fileable
Instruction 2023_08_23_e-NMSN_Software_Interface_Specification_Appendix_E_V1_6_DRAFT.docx Yes Yes Printable Only
Instruction 2023_08_23_e-NMSN_Software_Interface_Specification_Appendix_F_V1_6_DRAFT.docx Yes Yes Printable Only

Community and Social Services Social Services

 

5 0
   
State, Local, and Tribal Governments
 
   100 %

  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 25,000 0 25,000 0 0 0
Annual IC Time Burden (Hours) 250 0 250 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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