THE STATEMENT OF REASONABLE COST IS
COMPLETED BY HEALTH MAINTENANCE ORGANIZATIONS (HMOS) AFFILIATED
WITH MEDICARE. SUBMISSION OF THIS INFORMATION PERMITS THE HEALTH
CARE FINANCING ADMINISTRATION TO COMPUT THE REASONABLE COST OF HMO
SERVICE TO MEDICARE BENEFICIARIES, PERMITTING COMPUTATION OF
REIMBURSABLE RATE.
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.