MEDICAID MANAGEMENT INFORMATION SYSTEM

ICR 198302-0938-010

OMB: 0938-0247

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
113246 Migrated
ICR Details
0938-0247 198302-0938-010
Historical Active 198202-0938-001
HHS/CMS
MEDICAID MANAGEMENT INFORMATION SYSTEM
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 05/04/1983
Retrieve Notice of Action (NOA) 02/04/1983
  Inventory as of this Action Requested Previously Approved
08/31/1983 08/31/1983
40 0 0
1,057,800 0 0
0 0 0

THE MEDICAID MANAGEMENT INFORMATION SYSTEM (MMIS) IS A STATE-OPERATED, FEDERALLY-MANDATED, COMPUTER SYSTEM USED FOR MEDICAID CLAIMS PROCESSIN AND PROGRAM MANAGEMENT. THESE DATA ELEMENTS REPRESENT THE FEDERALLY IMPOSED RECORDKEEPING REQUIREMENTS OF THE MMIS, AND ONE-TIME SYSTEMS CHANGE BURDEN.

None
None


No

1
IC Title Form No. Form Name
MEDICAID MANAGEMENT INFORMATION SYSTEM HCFA-R-4

  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 40 0 0 40 0 0
Annual Time Burden (Hours) 1,057,800 0 0 1,057,800 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.
02/04/1983


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