EVALUATION OF MEDICARE AND MEDICAID ALCOHOLISM SERVICES DEMONSTRATION

ICR 198503-0938-030

OMB: 0938-0286

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
0938-0286 198503-0938-030
Historical Active 198410-0938-011
HHS/CMS
EVALUATION OF MEDICARE AND MEDICAID ALCOHOLISM SERVICES DEMONSTRATION
No material or nonsubstantive change to a currently approved collection   No
Emergency 03/04/1985
Approved with change 03/04/1985
Retrieve Notice of Action (NOA) 03/04/1985
  Inventory as of this Action Requested Previously Approved
06/30/1985 06/30/1985
0 0 0
0 0 0
0 0 0

INFORMATION COLLECTED THROUGH ADMISSION AND FOLLOW-UP FORMS WILL BE USED TO ASSESS ALTERNATIVE ALCOHOLISM TREATMENT SERVICES FOR MEDICAID ELIGIBLE PERSONS. OUTCOME DATA ARE NEEDED TO ASSESS THE ADEQUACY AND COSTS OF ALCOHOLISM TREATMENT IN NONHOSPITAL-BASED SETTINGS BY NON-MEDICAL PERSONNEL.

None
None


No

1
IC Title Form No. Form Name
EVALUATION OF MEDICARE AND MEDICAID ALCOHOLISM SERVICES DEMONSTRATION HCFA-429

  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 0 0 0 0 0 0
Annual Time Burden (Hours) 0 0 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
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.
03/04/1985


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