This revision
will be replaced by an integrated quality control form. Existing
clearance continues until 9/30/82.
Inventory as of this Action
Requested
Previously Approved
06/30/1982
09/30/1982
06/30/1982
155,438
0
155,438
969,600
0
969,600
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
AND UTILIZATION OF THIRD PARTIES. STATES AND HCFA DESIGN CORRECTIVE
ACTION 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.