MONTHLY STATISTICAL REPORT ON MEDICAL CARE

ICR 197903-0938-004

OMB: 0938-0060

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
112692 Migrated
ICR Details
0938-0060 197903-0938-004
Historical Active 197901-0938-001
HHS/CMS
MONTHLY STATISTICAL REPORT ON MEDICAL CARE
Revision of a currently approved collection   No
Regular
Approved without change 05/31/1979
Retrieve Notice of Action (NOA) 03/20/1979
  Inventory as of this Action Requested Previously Approved
09/30/1980 09/30/1980 09/30/1979
636 0 636
29,748 0 20,988
0 0 0

MONTHLY MEDICAID STATISTICAL DATA ARE COLLECTED AND PRESENTED TO MEET PRESSING CURRENT DEMANDS FOR MINIMUM INFORMATION ON MEDICAL CARE FINANCED UNDER TITLE XIX. THESE DATA ARE THE ONLY MONTHLY STATISTICAL DATA ON TITLE XIX AVAILABLE IN HCFA.

None
None


No

1
IC Title Form No. Form Name
MONTHLY STATISTICAL REPORT ON MEDICAL CARE HCFA-120

  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 636 636 0 0 0 0
Annual Time Burden (Hours) 29,748 20,988 0 0 8,760 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.
03/20/1979


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