Medicaid: Determining Third-Party Liability (TPL) State Plan Preprint and Supporting Regulations in 42 CFR 433.138

ICR 199908-0938-004

OMB: 0938-0502

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0502 199908-0938-004
Historical Active 199608-0938-002
HHS/CMS
Medicaid: Determining Third-Party Liability (TPL) State Plan Preprint and Supporting Regulations in 42 CFR 433.138
Extension without change of a currently approved collection   No
Regular
Approved without change 09/30/1999
Retrieve Notice of Action (NOA) 08/11/1999
  Inventory as of this Action Requested Previously Approved
09/30/2002 09/30/2002 10/31/1999
1,900,000 0 3,566,666
329,965 0 171,165
0 0 0

The information collected from Medicaid applicants and beneficiaries, as well as from State and local agencies is necessary to determine the legal liability of third parties to pay for medical services in lieu of Medicaid payment.

None
None


No

1
IC Title Form No. Form Name
Medicaid: Determining Third-Party Liability (TPL) State Plan Preprint and Supporting Regulations in 42 CFR 433.138 HCFA-R-0107

  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 1,900,000 3,566,666 0 -1,666,666 0 0
Annual Time Burden (Hours) 329,965 171,165 0 158,800 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
08/11/1999


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