REPORT ON PROVIDER PARTICIPATION IN THE MEDICAID PROGRAM

ICR 198207-0938-003

OMB: 0938-0262

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
113284 Migrated
ICR Details
0938-0262 198207-0938-003
Historical Active
HHS/CMS
REPORT ON PROVIDER PARTICIPATION IN THE MEDICAID PROGRAM
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 09/17/1982
Retrieve Notice of Action (NOA) 07/19/1982
  Inventory as of this Action Requested Previously Approved
09/30/1983 09/30/1983
54 0 0
2,160 0 0
0 0 0

FEDERAL MANAGERS NEED BASIC NATIONWIDE INFORMATION ON VARIOUS HEALTH CARE SERVICE PROVIDERS PARTICIPATING IN THE MEDICAID PROGRAM TO BETTER UNDERSTAND THE EFFECT OF MANAGEMENT DECISIONS ON STATE MEDICAID SERVIC DELIVERY SYSTEMS. THE REPORT WILL PROVIDE THIS INFORMATION AS WELL AS DATA NECESSARY FOR RESPONDING TO CONGRESSIONAL AND PUBLIC INQUIRIES.

None
None


No

1
IC Title Form No. Form Name
REPORT ON PROVIDER PARTICIPATION IN THE MEDICAID PROGRAM HCFA 350

  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 54 0 0 54 0 0
Annual Time Burden (Hours) 2,160 0 0 2,160 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
07/19/1982


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