INTEGRATED QUALITY CONTROL REVIEW WORKSHEET

ICR 198209-0938-002

OMB: 0938-0094

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
112860 Migrated
ICR Details
0938-0094 198209-0938-002
Historical Active 198201-0938-002
HHS/CMS
INTEGRATED QUALITY CONTROL REVIEW WORKSHEET
Revision of a currently approved collection   No
Regular
Approved without change 09/30/1982
Retrieve Notice of Action (NOA) 09/07/1982
  Inventory as of this Action Requested Previously Approved
10/31/1984 10/31/1984 09/30/1983
39,545 0 3,719
500,410 0 55,781
0 0 0

THE INTEGRATED WORKSHEET IS USED BY MQC, FOOD STAMPS QUALITY CONTROL, AND AFDC QUALITY CONTROL TO RECORD DATA FROM THE CASE RECORD EVALUATIO PERSONAL INTERVIEW, AND COLLATERAL CONTACTS PERFORMED DURING THE QC REVIEW. THIS FORM WILL REPLACE THE CURREN MQC INTEGRATED WORKSHEET, HCFA-316.

None
None


No

1
IC Title Form No. Form Name
INTEGRATED QUALITY CONTROL REVIEW WORKSHEET HCFA-316

  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 39,545 3,719 0 35,826 0 0
Annual Time Burden (Hours) 500,410 55,781 0 444,629 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.
09/07/1982


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