INFORMATION COLLECTION REQUIREMENTS FOR REQUESTING COST AVOIDANCE WAIVERS AS PROVIDED FOR IN BQC-64

ICR 199301-0938-003

OMB: 0938-0554

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0554 199301-0938-003
Historical Active 198909-0938-006
HHS/CMS
INFORMATION COLLECTION REQUIREMENTS FOR REQUESTING COST AVOIDANCE WAIVERS AS PROVIDED FOR IN BQC-64
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 04/05/1993
Retrieve Notice of Action (NOA) 01/11/1993
  Inventory as of this Action Requested Previously Approved
04/30/1996 04/30/1996
35 0 0
280 0 0
0 0 0

THE REGULATION ALLOWS STATES TO SEEK AND OBTAIN WAIVERS FROM USING THE COST AVOIDANCE METHOD OF CLAIMS PAYMENT WHEN A THIRD PARTY IS LIABLE. THE STATE MUST SUBMIT DOCUMENTATION TO SUBSTANTIATE THAT IT IS AT LEAS AS COST EFFECTIVE TO PAY CLAIMS AND SEEK RECOVERY FROM THE THIRD PARTY AS IT IS TO COST AVOID THE CLAIMS.

None
None


No

1
IC Title Form No. Form Name
INFORMATION COLLECTION REQUIREMENTS FOR REQUESTING COST AVOIDANCE WAIVERS AS PROVIDED FOR IN BQC-64 HCFA-R-121

  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 35 0 0 0 35 0
Annual Time Burden (Hours) 280 0 0 0 280 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.
01/11/1993


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