INFORMATION COLLECTION REQUIREMENTS IN BERC-240-F, RECOGNITION OF STATE REIMBURSEMENT CONTROL SYSTEM

ICR 198604-0938-006

OMB: 0938-0473

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0473 198604-0938-006
Historical Active
HHS/CMS
INFORMATION COLLECTION REQUIREMENTS IN BERC-240-F, RECOGNITION OF STATE REIMBURSEMENT CONTROL SYSTEM
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 06/28/1986
Retrieve Notice of Action (NOA) 04/28/1986
  Inventory as of this Action Requested Previously Approved
06/30/1989 06/30/1989
1 0 0
1 0 0
0 0 0

THIS INFORMATION IS REQUIRED BY HCFA TO VERIFY THAT EXPENDITURES UNDER STATE REIMBURSEMENT CONTROL SYSTEM DOES NOT EXCEED WHAT WOULD HAVE OTHERWISE BEEN PAID UNDER MEDICARE. THE INFORMATION IS SUBMITTED BY THE STATE.

None
None


No

1
IC Title Form No. Form Name
INFORMATION COLLECTION REQUIREMENTS IN BERC-240-F, RECOGNITION OF STATE REIMBURSEMENT CONTROL SYSTEM HCFA-R-49

  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 1 0 0 1 0 0
Annual Time Burden (Hours) 1 0 0 1 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.
04/28/1986


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