Information Collection Request

National Medical Support Notice - Part A

ICR 202401-0970-001 · OMB 0970-0222 · Active

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0970-0222 can be found here:

Forms and Documents

Document	Type	Status	Availability
Form Part A - Revised 2 National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (Employer Respondents)	Form	New	Available
Form Part A - Revised 2 National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (Employer Respondents)	Form	New	Missing upstream
Form Part A - Revised 2 National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (State Respondents)	Form	New	Repair queued
Form Part A - Revised 2 National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (State Respondents)	Form	New	Repair queued
Form NMSN Matrix State Medical Support Contacts and Program Requirement Matrix (State Respondents)	Form	Unchanged	Available
Form NMSN Matrix State Medical Support Contacts and Program Requirement Matrix (State Respondents)	Form	Unchanged	Repair queued
Form Part A - Revised 2 National Medical Support Notice-Part A (Employer Respondents)	Form	Unchanged	Available
Form Part A - Revised 2 National Medical Support Notice-Part A (Employer Respondents)	Form	Unchanged	Repair queued
Form Part A - Revised 2 National Medical Support Notice-Part A (State Respondents)	Form	Unchanged	Available
Form Part A - Revised 2 National Medical Support Notice-Part A (State Respondents)	Form	Unchanged	Repair queued
2023 e-NMSN record specifications-NMSN Part A_NonSub Change Request_1.2.24.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-01-02	Available
2023 e-NMSN record specifications-NMSN Part A_NonSub Change Request_1.2.24.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-01-02	Repair queued
NMSN Part A _NonSub Change Request_nc_3-2-23.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2023-03-02	Repair queued
NMSN Part A _NonSub Change Request_nc_3-2-23.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2023-03-02	Repair queued
NonSub Change Request - MNSN Updates 0970-0222.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2022-11-23	Available
NonSub Change Request - MNSN Updates 0970-0222.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2022-11-23	Repair queued
2022 10 27 Public Comments Received on the National Medical Support Notice Part A after 30 day comment period Responses Final for NC.docx	Supplementary Document	Uploaded 2022-11-23	Available
2022 10 27 Public Comments Received on the National Medical Support Notice Part A after 30 day comment period Responses Final for NC.docx	Supplementary Document	Uploaded 2022-11-23	Repair queued
Attachment A - Public Comments Received on the National Medical Support Notice Part A_final.docx	Supplementary Document	Uploaded 2022-09-16	Available
Attachment A - Public Comments Received on the National Medical Support Notice Part A_final.docx	Supplementary Document	Uploaded 2022-09-16	Missing upstream
2022 10 27 NMSN_Part_A_Sample_Form_after 30 day comment period clean Final to NC.docx	Supplementary Document	Uploaded 2022-11-23	Repair queued
2022 10 27 NMSN_Part_A_Sample_Form_after 30 day comment period clean Final to NC.docx	Supplementary Document	Uploaded 2022-11-23	Repair queued
NMSN Part A Supporting Statement _NonSub Chg - eNMSN_1.2.24.docx	Supporting Statement A	Uploaded 2024-01-02	Available
NMSN Part A Supporting Statement _NonSub Chg - eNMSN_1.2.24.docx	Supporting Statement A	Uploaded 2024-01-02	Available

IC Document Collections

IC ID	Collection	Type	Status
264137	National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (Employer Respondents)	Form	New
264137	National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (Employer Respondents)	Form	New
264134	National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (State Respondents)	Form	New
264134	National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (State Respondents)	Form	New
255976	State Medical Support Contacts and Program Requirement Matrix (State Respondents)	Form	Unchanged
255976	State Medical Support Contacts and Program Requirement Matrix (State Respondents)	Form	Unchanged
236881	National Medical Support Notice-Part A (Employer Respondents)	Form	Unchanged
236881	National Medical Support Notice-Part A (Employer Respondents)	Form	Unchanged
10060	National Medical Support Notice-Part A (State Respondents)	Form	Unchanged
10060	National Medical Support Notice-Part A (State Respondents)	Form	Unchanged

ICR Details

Status	Active
Agency/Subagency	HHS/ACF
OMB Control No	0970-0222
Type of Information Collection	No material or nonsubstantive change to a currently approved collection
Previous ICR Reference No	202302-0970-005
Agency Tracking No	OCSE
Date Submitted to OIRA	2024-01-03
Requested Expiration Date	1969-12-31