Information Collection Requirement in 42 CFR 447.53, Imposition of Cost Sharing Charges under Medicaid -- BERC 509

ICR 199802-0938-008

OMB: 0938-0429

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0429 199802-0938-008
Historical Active 199503-0938-007
HHS/CMS
Information Collection Requirement in 42 CFR 447.53, Imposition of Cost Sharing Charges under Medicaid -- BERC 509
Extension without change of a currently approved collection   No
Regular
Approved without change 04/22/1998
Retrieve Notice of Action (NOA) 02/25/1998
  Inventory as of this Action Requested Previously Approved
05/31/2001 05/31/2001 06/30/1998
54 0 54
2,700 0 2,700
0 0 0

Imposition of cost sharing charges under Medicaid (42 CFR 447.53). The information collection requirements contained in 42 CFR 447.53 requires States to include in their Medicaid State plan their provisions for charging cost sharing on medically and categorically needy beneficiaries.

None
None


No

1
IC Title Form No. Form Name
Information Collection Requirement in 42 CFR 447.53, Imposition of Cost Sharing Charges under Medicaid -- BERC 509 HCFA-R-53

  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 54 54 0 0 0 0
Annual Time Burden (Hours) 2,700 2,700 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.
02/25/1998


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