Internal Revenue Service/Social Security Administration/ Health Care Financing Administration Data Match -- 42 CFR 411.20-411.206

ICR 199702-0938-002

OMB: 0938-0565

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0565 199702-0938-002
Historical Active 199610-0938-012
HHS/CMS
Internal Revenue Service/Social Security Administration/ Health Care Financing Administration Data Match -- 42 CFR 411.20-411.206
Revision of a currently approved collection   No
Regular
Approved without change 04/15/1997
Retrieve Notice of Action (NOA) 02/14/1997
Approved for use through 4/2000 under the following conditions: 1) no later than 4/1998, HCFA explains how the proposed MTS release(s) supporting coordination of benefits functions will interface with the ongoing data match initiative; and 2) no later than 10/97, HCFA submits to OMB a summary of the comments and questions concerning burden that have been received from the private sector and a reevaluation of the assumption that the Data Match report does not impose capital costs on firms, e.g. invest- ments in new or enhanced heatlh benefits claims/ administrator services, information technology, etc.
  Inventory as of this Action Requested Previously Approved
04/30/2000 04/30/2000 04/30/1997
596,241 0 596,241
2,325,449 0 2,325,449
0 0 0

Employers identified through a match of IRS, SSA, and Medicare records will be contacted concerning group health coverage of identified individuals to ensure compliance with Medicare secondary payer provisions found at 42 U.S.C. 1395y(b).

None
None


No

1
IC Title Form No. Form Name
Internal Revenue Service/Social Security Administration/ Health Care Financing Administration Data Match -- 42 CFR 411.20-411.206 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 596,241 596,241 0 0 0 0
Annual Time Burden (Hours) 2,325,449 2,325,449 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.
02/14/1997


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