Choice Care: A Medicaid Consumers Value/Preference and Report Card Model for Health Plan Selection

ICR 199609-0935-002

OMB: 0935-0101

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0935-0101 199609-0935-002
Historical Active 199606-0920-003
HHS/AHRQ
Choice Care: A Medicaid Consumers Value/Preference and Report Card Model for Health Plan Selection
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 09/24/1996
Retrieve Notice of Action (NOA) 09/24/1996
This information collection is approved through 7-97 under the following conditions: As discussed with the Agency, CDC will not use an incentive payment for respondents in this evaluation. CDC will also modify the race/ethnicity classifications used in each survey to meet the OMB Statistical Policy Directive Number 15. Specifically, CDC will add "not of hispanic origin" after "Black or African American" and "White."
  Inventory as of this Action Requested Previously Approved
07/31/1997 07/31/1997
200 0 0
50 0 0
0 0 0

The purpose of the Choice Card project is to develop an automated kiosk-based application to assist Medicaid recipients in selecting and enrolling in a health plan. The proposed data collection will obtain assessments from users.

None
None


No

1
IC Title Form No. Form Name
Choice Care: A Medicaid Consumers Value/Preference and Report Card Model for Health Plan Selection

  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 200 0 0 200 0 0
Annual Time Burden (Hours) 50 0 0 50 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
Yes Part B of Supporting Statement
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.
09/24/1996


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