Approved for use
through 10/97 under the conditions that: 1) HCFA will accept copies
of state-mandated submissions if such reports include all of the
necessary elements of information as required by HCFA and the
statute; and 2) MCOs may maintain records supporting the summary
reports in any format, as long as it is possible to understand and
derive from these detailed records all summary statistics reported
to HCFA.
Inventory as of this Action
Requested
Previously Approved
11/30/1997
11/30/1997
450
0
0
45,000
0
0
0
0
0
Data collection will be used to
demonstrate and monitor compliance with the statute governing
physician incentives under Medicare and Medicaid managed
care.
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.
Incentive Arrangement Disclosure Form and Supporting Regulations -- 42 CFR 417.479, 417.500, 434.44, 434.67, 434.70, 1003.100, 1003.101, 1003.103