WORKSHEET FOR INTEGRATED AFDC, ADULT, FOOD STAMPS AND MEDICAID ELIGIBILITY QUALITY CONTROL REVIEWS

ICR 199102-0970-002

OMB: 0970-0072

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0970-0072 199102-0970-002
Historical Active 199010-0970-003
HHS/ACF
WORKSHEET FOR INTEGRATED AFDC, ADULT, FOOD STAMPS AND MEDICAID ELIGIBILITY QUALITY CONTROL REVIEWS
Revision of a currently approved collection   No
Regular
Approved without change 04/11/1991
Retrieve Notice of Action (NOA) 02/26/1991
  Inventory as of this Action Requested Previously Approved
03/31/1994 03/31/1994 10/31/1991
63,000 0 63,000
694,487 0 694,487
0 0 0

THE INTEGRATED WORKSHEET SERVES TO DOCUMENT THE FIND- INGS OF STATE QUALITY CONTROL REVIEWERS WHO REVIEW THE CORRECTNESS OF A SAMPLE OF ELIGIBILITY DECISIONS MADE BY THE STATES FOR THE AFDC, FOOD STAMP, AND MEDICAID PROGRAMS. THE FINDINGS ARE USED TO IDENTIFY AREAS WHERE CORRECTIVE ACTION IS NEEDED.

None
None


No

1
IC Title Form No. Form Name
WORKSHEET FOR INTEGRATED AFDC, ADULT, FOOD STAMPS AND MEDICAID ELIGIBILITY QUALITY CONTROL REVIEWS FSA-4340

  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 63,000 63,000 0 0 0 0
Annual Time Burden (Hours) 694,487 694,487 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.
02/26/1991


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