QUALITY CONTROL NEGATIVE CASE ACTION WORKSHEET/REVIEW SCHEDULE - TABLE 1

ICR 198403-0960-011

OMB: 0960-0156

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0960-0156 198403-0960-011
Historical Active 198205-0960-006
SSA
QUALITY CONTROL NEGATIVE CASE ACTION WORKSHEET/REVIEW SCHEDULE - TABLE 1
Revision of a currently approved collection   No
Regular
Approved without change 06/04/1984
Retrieve Notice of Action (NOA) 03/19/1984
  Inventory as of this Action Requested Previously Approved
03/31/1987 03/31/1987 06/30/1984
20,228 0 40,114
20,228 0 40,228
0 0 0

THE QC NEGATIVE CASE ACTION REVIEW PROMOTES PROPER STATE ADMINISTRATIO OF THEIR AFDC, ADULT AND MEDICAID PROGRAMS BY HELPING TO ASSESS PERFORMANCE IN THE DENIAL OR TERMINATION OF BENEFITS. THE STATE COMPLETES FORM SSA-6401 (WORKSHEET/REVIEW SCHEDULE) FOR EACH CASE IN THE SAMPLE. THE COMPLETED FORM IS RETAINED IN THE STATE OFFICE. AFTE EACH REVIEW PERIOD, THE STATE COMPLETES AND SENDS TO THE FEDERAL GOVERNMENT A SUMMARY OF THE DATA ON STATISTICAL TABLE 1.

None
None


No

1
IC Title Form No. Form Name
QUALITY CONTROL NEGATIVE CASE ACTION WORKSHEET/REVIEW SCHEDULE - TABLE 1 SSA-6401

  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 20,228 40,114 0 -19,886 0 0
Annual Time Burden (Hours) 20,228 40,228 0 -20,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes

$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.
03/19/1984


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