MEDICAID QUALITY CONTROL REVIEW SCHEDULE & WORKSHEET

ICR 197805-0938-004

OMB: 0938-0069

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
166139 Migrated
ICR Details
0938-0069 197805-0938-004
Historical Active 197803-0938-004
HHS/CMS
MEDICAID QUALITY CONTROL REVIEW SCHEDULE & WORKSHEET
No material or nonsubstantive change to a currently approved collection   No
Emergency 05/10/1978
Approved with change 05/10/1978
Retrieve Notice of Action (NOA) 05/10/1978
  Inventory as of this Action Requested Previously Approved
03/31/1979 03/31/1979 03/31/1979
157,460 0 157,460
1,582,779 0 1,681,620
0 0 0



None
None


No

1
IC Title Form No. Form Name
MEDICAID QUALITY CONTROL REVIEW SCHEDULE & WORKSHEET HCFA-301

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 157,460 157,460 0 0 0 0
Annual Time Burden (Hours) 1,582,779 1,681,620 0 0 -98,841 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
05/10/1978


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