HCFA 301 HAS
BEEN APPROVED FOR USE ONLY THROUGH JUNE 30, l982. IT IS OUR
INTENTION THAT THIS FORM BE UTILIZED NATIONALLY FOR ELIGIBILITY
REVIEW ON THE OCTOBER l98l-MARCH l982 SAMPLE DATA, AND FOR CPE
REVIEWS ON THE APRIL l98l- SEPTEMBER l98l SAMPLE DATA. BEGINNING
IMMEDIATELY USE OF THE HCFA 301 CPE SEGMENT FOR SAMPLE DATA
SUBSEQUENT TO SEPT. 19 WILL BE APPROVED ONLY FOR THOSE STATES WHOSE
MOST RECENTLY REPORTED UNDUPLICATED CPE PAYMENT ERRORS EXCEED BOTH
ONE PERCENTAGE POINT OF PAYMENTS AND ONE MILLION DOLLARS OF FEDERAL
COSTS. ADDITIONAL CONDITIONS IN LETTER TO ROBERT SERMIER FROM JIM
TOZZI DATED 3/5/82 ATTACHED.
Inventory as of this Action
Requested
Previously Approved
06/30/1982
06/30/1982
155,438
0
0
969,600
0
0
0
0
0
THE HCFA 301 AND WORKSHEETS ARE USED
BY THE STATES TO SUMMARIZE MQC REVIEW FINDINGS. THESE DATA ARE USED
BY MQC TO DETERMINE THE ACCURACY OF THE ELIGIBILITY DETERMINATIONS,
CLAIMS PROCESSING SYSTEMS, AND UTILIZATION OF THIRD PARTIES. STATES
AND HCFA DESIGN CORRECTIVE ACTIO INITIATIVES BASED ON THESE MQC
DATA.
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.