SEC. 4440, STATE MEDICAID MANUAL HOME AND COMMUNITY BASED SERVICES

ICR 198212-0938-001

OMB: 0938-0272

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-0272 198212-0938-001
Historical Active
HHS/CMS
SEC. 4440, STATE MEDICAID MANUAL HOME AND COMMUNITY BASED SERVICES
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 01/11/1983
Retrieve Notice of Action (NOA) 12/02/1982
  Inventory as of this Action Requested Previously Approved
11/30/1984 11/30/1984
50 0 0
1,250 0 0
0 0 0

STATES ELECTING TO REQUEST A WAIVER ARE REQUIRED BY LAW TO PROVIDE CERTAIN ASSURANCES AND DOCUMENTATION. THIS INFORMATION IS USED TO ENSURE THAT (1) THE RECIPIENTS' HEALTH AND WELFARE IS PROTECTED, (2) THE PROGRAM IS COST-EFFECTIVE, AND (3) THE SERVICES PROVIDED ARE APPROPRIATE. THIS INSTRUCTION PERMITS STATES TO REQUEST A WAIVER FOR A SELECTED GROUP OF BENEFICIARIES.

None
None


No

1
IC Title Form No. Form Name
SEC. 4440, STATE MEDICAID MANUAL HOME AND COMMUNITY BASED SERVICES HCFA-382

  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 50 0 0 50 0 0
Annual Time Burden (Hours) 1,250 0 0 1,250 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.
12/02/1982


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