MEDICAID ELIGIBILITY QUALITY CONTROL - INFORMATION COLLECTION REQUIREMENTS IN 42 CFR 431.804(D)(3) AND (4)

ICR 198912-0938-002

OMB: 0938-0344

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0344 198912-0938-002
Historical Active 198812-0938-002
HHS/CMS
MEDICAID ELIGIBILITY QUALITY CONTROL - INFORMATION COLLECTION REQUIREMENTS IN 42 CFR 431.804(D)(3) AND (4)
Revision of a currently approved collection   No
Regular
Approved without change 02/23/1990
Retrieve Notice of Action (NOA) 12/11/1989
This information collection request is approved through December, 1990 The next submission should reflect changes in the rebuttal procedures as set forth in the final rulemaking on the proposed Medicaid Eligibility Quality Control (MEQC) rulemaking (BQC-21-F).
  Inventory as of this Action Requested Previously Approved
12/31/1990 12/31/1990 02/28/1990
10 0 10
2,316 0 2,316
0 0 0

THE INFORMATION BEING COLLECTED IS AN OPTION ADDITIONAL SAMPLE OF MEDICAID ELIGIBILITY CASES WHICH MAY BE USED BY MEDICAID STATE AGENCIES TO DEMONSTRATE THAT THEIR ACTUAL CURRENT ERROR RATE IS LOWER THAN THAT PROJECTED BY HCFA.

None
None


No

1
IC Title Form No. Form Name
MEDICAID ELIGIBILITY QUALITY CONTROL - INFORMATION COLLECTION REQUIREMENTS IN 42 CFR 431.804(D)(3) AND (4) HCFA-R-37

  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 10 10 0 0 0 0
Annual Time Burden (Hours) 2,316 2,316 0 0 0 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.
12/11/1989


© 2024 OMB.report | Privacy Policy