INFORMATION COLLECTION REQUIREMENTS IN THE SYSTEM PERFORMANCE REVIEW, MEDICAID

ICR 199406-0938-002

OMB: 0938-0487

Federal Form Document

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Document
Name
Status
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ICR Details
0938-0487 199406-0938-002
Historical Active 199102-0938-004
HHS/CMS
INFORMATION COLLECTION REQUIREMENTS IN THE SYSTEM PERFORMANCE REVIEW, MEDICAID
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 08/22/1994
Retrieve Notice of Action (NOA) 06/06/1994
  Inventory as of this Action Requested Previously Approved
08/31/1997 08/31/1997
22 0 0
44,000 0 0
0 0 0

THE SYSTEM PERFORMANCE REVIEW (SPR) IS A VEHICLE USED TO EVALUATE STAT MEDICARE MANAGEMENT INFORMATION SYSTEMS (MMIS) TO DETERMINE WHETHER OR NOT A STATE SYSTEM SATISFIES THE FUNCTIONAL REQUIREMENTS AND STATISTICAL LEVELS OF OUTPUT RELATING TO ACCURACY AND TIMELESS. THIS REVIEW NECESSITATES THE DOCUMENTATION OR MAINTENANCE OF SPECIFIC RECORDS.

None
None


No

1
IC Title Form No. Form Name
INFORMATION COLLECTION REQUIREMENTS IN THE SYSTEM PERFORMANCE REVIEW, MEDICAID HCFA-R-86

  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 22 0 0 22 0 0
Annual Time Burden (Hours) 44,000 0 0 44,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
06/06/1994


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