REVISIONS TO THE MEDICAID STATE PLAN PREPRINT, SUPPLEMENT 9 TO ATTACHMENT 2.6-A, FOR TRANSFER OF RESOURCES

ICR 198408-0938-013

OMB: 0938-0193

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0193 198408-0938-013
Historical Active 198301-0938-005
HHS/CMS
REVISIONS TO THE MEDICAID STATE PLAN PREPRINT, SUPPLEMENT 9 TO ATTACHMENT 2.6-A, FOR TRANSFER OF RESOURCES
Revision of a currently approved collection   No
Regular
Approved without change 10/16/1984
Retrieve Notice of Action (NOA) 08/17/1984
  Inventory as of this Action Requested Previously Approved
03/31/1985 03/31/1985 03/31/1985
54 0 862
3,640 0 3,478
0 0 0

MEDICAID STATE AGENCIES THAT DENY MEDICAL ASSISTANCE DUE TO DISPOSAL OF RESOURCES ARE REQUIRED BY SECTION 1917(C) OF THE SOCIAL SECURITY AC TO SPECIFY IN THE STATE PLAN THEIR PROCEDURES FOR IMPLEMENTING THE DENIAL.

None
None


No

1
IC Title Form No. Form Name
REVISIONS TO THE MEDICAID STATE PLAN PREPRINT, SUPPLEMENT 9 TO ATTACHMENT 2.6-A, FOR TRANSFER OF RESOURCES HCFA-179

  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 54 862 0 -808 0 0
Annual Time Burden (Hours) 3,640 3,478 0 162 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.
08/17/1984


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