SURVEY OF MEDICAID REIMBURSEMENT POLICIES

ICR 198001-0938-003

OMB: 0938-0134

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
166175 Migrated
ICR Details
0938-0134 198001-0938-003
Historical Active 197912-0938-002
HHS/CMS
SURVEY OF MEDICAID REIMBURSEMENT POLICIES
No material or nonsubstantive change to a currently approved collection   No
Emergency 01/21/1980
Approved with change 01/21/1980
Retrieve Notice of Action (NOA) 01/21/1980
  Inventory as of this Action Requested Previously Approved
08/31/1980 08/31/1980 05/31/1980
50 0 50
200 0 200
0 0 0



None
None


No

1
IC Title Form No. Form Name
SURVEY OF MEDICAID REIMBURSEMENT POLICIES HCFA-167T,, HCFA-L-, 167T

  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 50 50 0 0 0 0
Annual Time Burden (Hours) 200 200 0 0 0 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.
01/21/1980


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