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Federal forms, ICRs, and supporting documents

Information Collection Request

INTERNAL REVENUE SERVICE/SOCIAL SECURITY ADMINISTRATION HEALTH CARE FINANCING ADMINISTRATION DATA MATCH PROJCT (42 USC 1395Y(B)(5))

ICR 199108-0938-012 · OMB 0938-0565 · Historical Active

Forms and Documents
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IC IDCollectionTypeStatusForm
113988 INTERNAL REVENUE SERVICE/SOCIAL SECURITY ADMINISTRATION HEALTH CARE FINANCING ADMINISTRATION DATA MATCH PROJCT (42 USC 1395Y(B)(5)) Form Migrated
ICR Details
0938-0565 199108-0938-012
Historical Active 199007-0938-001
HHS/CMS
INTERNAL REVENUE SERVICE/SOCIAL SECURITY ADMINISTRATION HEALTH CARE FINANCING ADMINISTRATION DATA MATCH PROJCT (42 USC 1395Y(B)(5))
Revision of a currently approved collection   No
Regular
Approved without change 11/27/1991
Retrieve Notice of Action (NOA) 08/29/1991
Approved for use through 11/92 under the condition that HCFA develop and present to OMB a statistically valid sampling methodology and implementation plan that will enable HCFA to achieve the following: 1) A more accurate estimate of private and public paperwork burden and related administrative costs -- Several commenters estimate that burde hours and cost are almost double what HCFA projects. HCFA should evaluate burden not only by size of the employer but also to the maxim extent possible by the nature of the business and its daily operations 2) Tracking of actual Federal savings after contractor collections and the Federal and private costs incurred through related activities such as litigation, record retrieval, etc.; and 3) Ongoing refinement of the data match to ensure that Federal savings exceed private and public administrative costs. HCFA should meet with OMB no later than 12/91 to discuss its sampling methodology and implementation plan. Pursuant to this plan, if deemed appropriate HCFA should submit a revised burden and cost estimate as well as alternative criteria for targetting employees and firms.
  Inventory as of this Action Requested Previously Approved
11/30/1992 11/30/1992 09/30/1991
1,100,000 0 1,100,000
3,293,450 0 3,483,333
0 0 0
EMPLOYERS IDENTIFIED THROUGH A MATCH OF IRS, SSA, AND MEDICARE RECORDS WILL BE CONTACTED CONCERNING GROUP HEALTH PLAN COVERAGE OF IDENTIFIED EMPLOYEES TO ENSURE COMPLIANCE WITH THE MEDICARE SECONDARY PAYER PROVISIONS FOUND AT 42 USC 1395Y(B).
None
None
No
1
IC Title Form No. Form Name
INTERNAL REVENUE SERVICE/SOCIAL SECURITY ADMINISTRATION HEALTH CARE FINANCING ADMINISTRATION DATA MATCH PROJCT (42 USC 1395Y(B)(5)) HCFA-R-137
  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 1,100,000 1,100,000 0 0 0 0
Annual Time Burden (Hours) 3,293,450 3,483,333 0 0 -189,883 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.
08/29/1991