INFORMATION COLLECTION REQUIREMENTS IN BERC 504F AND BPP-504, MEDICAID CONTRACTS WITH HEALTH MAINTENANCE ORGANIZATIONS AND PREPAID HEALTH PLANS

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IC ID	Collection	Type	Status	Form
113427	INFORMATION COLLECTION REQUIREMENTS IN BERC 504F AND BPP-504, MEDICAID CONTRACTS WITH HEALTH MAINTENANCE ORGANIZATIONS AND PREPAID HEALTH PLANS	Form	Migrated

ICR Details

OMB Control No: 0938-0326	ICR Reference No: 198311-0938-006
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: INFORMATION COLLECTION REQUIREMENTS IN BERC 504F AND BPP-504, MEDICAID CONTRACTS WITH HEALTH MAINTENANCE ORGANIZATIONS AND PREPAID HEALTH PLANS
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/19/1984
	Date Received in OIRA: 11/25/1983
Terms of Clearance: THIS COLLECTION HAS BEEN EXPANDED TO INCLUDE REPORTING AND RECORDKEEPI REQUIREMENTS PREVIOUSLY APPROVED UNDER 0938-0327. THESE REQUIREMENTS MAY BE FOUND AT: 434.6[a][2] thru [6], [9] thru [11], [15], and [16] 434.10[b] 434.12[b][c] 434.14[a][5] thru [8] UNDER THE PROVISIONS UNDER 1320.14[f], OMB REQUESTS THAT HHS INITIATE RULEMAKING TO REVISE INFORMATION COLLECTION REQUIREMENTS IN SECTIONS 434.27[a][3], 434.36, AND 434.55. SPECIFICALLY, THE REQUIREMENT FOR STATE AGENCY REVIEW OF INDIVIDUAL HMO TERMINATIONS AND MARKETING REQUIREMENT IS EXCESSIVELY PRESCRIPTIVE. STATES SHOULD BE GIVEN THE FLEXIBILITY TO DETERMINE THE NEED FOR SUCH REVIEWS. A NOTICE MUST BE PUBLISHED IN THE FEDERAL REGISTER ON THE NEXT PRACTICABLE DATE REGARDI THIS ACTION. THIS RULEMAKING MUST BE INITIATED WITHIN 120 DAYS.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/1985	01/31/1985
Responses	696	0	0
Time Burden (Hours)	128,400	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: THIS CLEARANCE REQUEST CONSISTS OF INFORMATION COLLECTION REQUIREMENTS INCLUDED IN CONTRACTS MEDICAID STATE AGENCIES AND HEALTH MAINTENANCE ORGANIZATIONS. THESE REQUIREMENTS ARE NECESSARY TO ENSURE THAT RECIPIENTS ARE TREATED, SERVICES ARE RENDERED AND REIMBURSEMENT IS MADE IN A MANNER CONSISTENT WITH TITLE XIX.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
INFORMATION COLLECTION REQUIREMENTS IN BERC 504F AND BPP-504, MEDICAID CONTRACTS WITH HEALTH MAINTENANCE ORGANIZATIONS AND PREPAID HEALTH PLANS	R-27, R-28

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ICR Summary of Burden

table that charts list of burden

	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	696	0	0	696	0	0
Annual Time Burden (Hours)	128,400	0	0	128,400	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 11/25/1983

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