Information Collection Request
Electronic Funds Transfer Authorization Agreement (CMS-588)
ICR 202305-0938-005 · OMB 0938-0626 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-588 Electronic Funds Transfer Authorization Agreement |
Form and Instruction | Modified | Repair queued |
 CMS-588 - Supporting Statemen t.docx |
Supporting Statement A | Uploaded 2023-05-11 | Repair queued |
 CMS-588 - Crosswalk of Changes.xlsx |
Supplementary Document | Uploaded 2023-05-10 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 43660 |  Electronic Funds Transfer Authorization Agreement |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-0626 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 201912-0938-021 |
| Agency Tracking No | CPI - 588 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |