Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (Employer Respondents) New 93 1 0 Form Part A - Revised 2023 National Medical Support Notice Part A
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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) New 25000 250 0 Form Part A - Revised 2023 National Medical Support Notice Part A
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National Medical Support Notice-Part A (Employer Respondents) Unchanged 4875904 828904 0 Form Part A - Revised 2023 National Medical Support Notice Part A
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National Medical Support Notice-Part A (State Respondents) Unchanged 4870476 827981 0 Form Part A - Revised 2023 National Medical Support Notice Part A
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State Medical Support Contacts and Program Requirement Matrix (State Respondents) Unchanged 54 54 0 Form NMSN Matrix State Medical Support Contacts and Program Requirement Matrix
Total burden requested under this ICR: 9771527 1657190 0  
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