HEALTH CARE PROGRAM VIOLATIONS NOTIFICATION FORM

ICR 198705-0990-001

OMB: 0990-0141

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
116696
Migrated
ICR Details
0990-0141 198705-0990-001
Historical Active 198404-0990-004
HHS/HHSDM
HEALTH CARE PROGRAM VIOLATIONS NOTIFICATION FORM
Revision of a currently approved collection   No
Regular
Approved without change 08/05/1987
Retrieve Notice of Action (NOA) 05/13/1987
  Inventory as of this Action Requested Previously Approved
08/31/1990 08/31/1990 08/31/1987
450 0 775
38 0 65
0 0 0

THE REGULATION PROMULGATES AND ESTABLISHES APPLICATION REQUIREMENTS TO ENABLE STATE GOVERNMENTS TO RECEIVE FEDERAL FUNDING FOR THE OPERATION OF CERTIFIED MEDICAID FRAUD CONTROL UNITS. THE INFORMATION COLLECTED NECESSARY TO MONITOR AND INSURE THAT COSTS CHARGED TO FEDERAL FUNDS AR ALLOWABLE AND PERTAIN TO FRAUD AGAINST THE MEDICAID PROGRAM.

None
None


No

1
IC Title Form No. Form Name
HEALTH CARE PROGRAM VIOLATIONS NOTIFICATION FORM

  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 450 775 0 0 -325 0
Annual Time Burden (Hours) 38 65 0 0 -27 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.
05/13/1987


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