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Information Collection

Title Xix Superior Utilization Review (ur) System Waiver Request Information Collection Requirement-sections 9320-9330 Of State Medicaid Manual

IC 113829 under ICR 198907-0938-002 · OMB 0938-0479.

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TITLE XIX SUPERIOR UTILIZATION REVIEW (UR) SYSTEM WAIVER REQUEST INFORMATION COLLECTION REQUIREMENT-SECTIONS 9320-9330 OF STATE MEDICAID MANUAL
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form HCFA-R-95 No No


    

25 0
   
State, Local, and Tribal Governments
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 25 0 0 0 0 25
Annual IC Time Burden (Hours) 300 0 0 0 0 300
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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