Medicaid Sterilization Regulations and Consent Form and Supporting Regulations -- 45 CFR 96.73, 42 CFR 441, Subpart F

ICR 199710-0938-006

OMB: 0938-0481

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0481 199710-0938-006
Historical Active 199410-0938-011
HHS/CMS
Medicaid Sterilization Regulations and Consent Form and Supporting Regulations -- 45 CFR 96.73, 42 CFR 441, Subpart F
Extension without change of a currently approved collection   No
Regular
Approved without change 12/22/1997
Retrieve Notice of Action (NOA) 10/24/1997
  Inventory as of this Action Requested Previously Approved
01/31/2001 01/31/2001 01/31/1998
112,526 0 203,036
140,658 0 203,036
0 0 0

All medicaid-eligible individuals seeking sterilization are required to provide informed consent, acknowledging that they understand the benefits and risks, utilizing the federally mandated consent form.

None
None


No

1
IC Title Form No. Form Name
Medicaid Sterilization Regulations and Consent Form and Supporting Regulations -- 45 CFR 96.73, 42 CFR 441, Subpart F HCFA-R-94

  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 112,526 203,036 0 0 -90,510 0
Annual Time Burden (Hours) 140,658 203,036 0 0 -62,378 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.
10/24/1997


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