National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (Employer Respondents) - 2026 Forward

National Medical Support Notice - Part A

OMB: 0970-0222

IC ID: 277536

Documents and Forms
Document Name
Document Type
Instruction
Instruction
Instruction
Form
Information Collection (IC) Details

View Information Collection (IC)

National Medical Support Notice – Part A – Notice to Withhold for Health Care Coverage e-NMSN record specification layout Electronic system to system (Employer Respondents) - 2026 Forward
 
No New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction NMSN Part A_Sample_Clean.docx Yes Yes Fillable Printable
Instruction 2025_06_11_e-NMSN_Software_Interface_Specification__Clean.pdf Yes Yes Printable Only
Form 1 National Medical Support Notice Part A NMSN Part A clean.docx Yes Yes Fillable Fileable
Instruction NMSN_Supplemental_Instructions_clean.docx Yes Yes Printable Only

Community and Social Services Social Services

 

25 0
   
State, Local, and Tribal Governments
 
   100 %

  Requested 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 93 0 93 0 0 0
Annual IC Time Burden (Hours) 1 0 1 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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