MEDICAID - INFORMATION COLLECTION REQUIREMENTS IN THE SYSTEM PERFORMANCE REVIEW

ICR 198606-0938-001

OMB: 0938-0487

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-0487 198606-0938-001
Historical Active
HHS/CMS
MEDICAID - INFORMATION COLLECTION REQUIREMENTS IN THE SYSTEM PERFORMANCE REVIEW
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 06/30/1986
Retrieve Notice of Action (NOA) 06/30/1986
  Inventory as of this Action Requested Previously Approved
09/30/1986 09/30/1986
45 0 0
65,000 0 0
0 0 0

THE SYSTEM PERFORMANCE REVIEW (SPR) IS A VEHICLE USED TO EVALUATE STATE MEDICAID MANAGEMENT INFORMATION SYSTEMS (MMIS) TO DETERMINE WHETHER OR NOT A STATE SYSTEM SATISFIES THE FUNCTIONAL REQUIREMENTS AND STATISTICAL LEVELS OF OUTPUT RELATING TO ACCURACY AND TIMELINESS. THIS REVIEW NECESSITATES THE DOCUMENTATION OR MAINTENANCE OF SPECIFIED RECORDS.

None
None


No

1
IC Title Form No. Form Name
MEDICAID - INFORMATION COLLECTION REQUIREMENTS IN THE SYSTEM PERFORMANCE REVIEW HCFA-R-86

  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 45 0 0 0 45 0
Annual Time Burden (Hours) 65,000 0 0 0 65,000 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.
06/30/1986


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