MEDICAID - INFORMATION COLLECTION REQUIREMENTS IN HSQ-127-F 42 CFR SECTIONS 442.114(A), 441.115(A) AND 442.116(A)(C) AND (D)

ICR 198802-0938-002

OMB: 0938-0521

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0521 198802-0938-002
Historical Active
HHS/CMS
MEDICAID - INFORMATION COLLECTION REQUIREMENTS IN HSQ-127-F 42 CFR SECTIONS 442.114(A), 441.115(A) AND 442.116(A)(C) AND (D)
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 04/12/1988
Retrieve Notice of Action (NOA) 02/11/1988
  Inventory as of this Action Requested Previously Approved
04/30/1990 04/30/1990
15 0 0
263 0 0
0 0 0

THIS INFORMATION COLLECTION PROVIDES OPTIONS TO THE STATE MEDICAID AGENCY TO SUBMIT EITHER WRITTEN PLANS EITHER TO CORRECT DEFICIENCIES OR TO REDUCE THE NUMBER OF BEDS I CERTIFIED UNITS RATHER THAN BE EXCLUDED FROM THE MEDICAID PROGRAM. TH INFORMATION IS USED BY HCFA TO MAKE DECISIONS REGARDING ICF/MRS RIGHTS TO PARTICIPATE IN THE MEDICAID PROGRAM.

None
None


No

1
IC Title Form No. Form Name
MEDICAID - INFORMATION COLLECTION REQUIREMENTS IN HSQ-127-F 42 CFR SECTIONS 442.114(A), 441.115(A) AND 442.116(A)(C) AND (D) HCFA-R-108

  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 15 0 0 15 0 0
Annual Time Burden (Hours) 263 0 0 263 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.
02/11/1988


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