STATISTICAL REPORT ON MEDICAL CARE: ELIGIBLES, RECIPIENTS, PAYMENTS, AND SERVICES "MEDICAID"

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Forms and supporting documents for this ICR

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IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
113480	STATISTICAL REPORT ON MEDICAL CARE: ELIGIBLES, RECIPIENTS, PAYMENTS, AND SERVICES "MEDICAID"	Form	Migrated

ICR Details

OMB Control No: 0938-0345	ICR Reference No: 198901-0938-009
Status: Historical Active	Previous ICR Reference No: 198803-0938-008
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: STATISTICAL REPORT ON MEDICAL CARE: ELIGIBLES, RECIPIENTS, PAYMENTS, AND SERVICES "MEDICAID"
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/27/1989
	Date Received in OIRA: 01/27/1989
Terms of Clearance: This information collection is approved until 2/28/90, under these terms of clearance: 1. HCFA will, in conjunction with its workgroup on future data needs, conduct an analysis on the hardcopy 2082 and scrutinize the rows currently in place, particularly with respect to the recent changes mandated by the Medicare Catastrphic Act of 1988. 2. Within this review, HCFA will devise a scheme to report on on the qualified medicare beneficiaries (QMBs) group, separate from other groups, to the extent possible. 3. HCFA will devise a new scheme to report on pregnant women and young children and infants, separate from other groups and to the extent possible. 4. HCFA will devise a scheme to report on Unemployed Parents and transitional beneficiaries, separate from other groups and to the extent possible, within the context of the Family Support Act of 1988 and other relevant statutes. 5. HCFA will, within the context of its working group on future data needs, study the possibility of including a scheme which includes income based criteria in its reporting, within the context of States' ability to report such data to HCFA. HCFA will provide OMB with this information by the next clearance.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/1990	02/28/1990	06/30/1989
Responses	51	0	46
Time Burden (Hours)	19,845	0	19,602
Cost Burden (Dollars)	0	0	0

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Abstract: THE DATA REPORTED IN THE HCFA2082 ARE THE BASIS OF ACTUARIAL FORECASTS FOR MEDICAID SERVICE UTILIZATION AND COSTS, OF ANALYSES AND COST MEDICAID, AND FOR RESPONDING TO REQUESTS FOR INFORMATION FROM HCFA COMPONENTS, THE DEPARTMENT, THE PUBLIC, THE PRESS, AND THE CONGRESS.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
STATISTICAL REPORT ON MEDICAL CARE: ELIGIBLES, RECIPIENTS, PAYMENTS, AND SERVICES "MEDICAID"	HCFA-2082, MEDSTAT

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ICR Summary of Burden

table that charts list of burden

	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	51	46	0	5	0	0
Annual Time Burden (Hours)	19,845	19,602	0	243	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 01/27/1989

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