TANF High Performance Bonus Report, Assessment of Medicaid and SCHIP Enrollment Among Individuals After Leaving TANF Assistance

ICR 200105-0992-001

OMB: 0992-0007

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0992-0007 200105-0992-001
Historical Active
HHS/OFA
TANF High Performance Bonus Report, Assessment of Medicaid and SCHIP Enrollment Among Individuals After Leaving TANF Assistance
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 07/30/2001
Retrieve Notice of Action (NOA) 05/24/2001
This information collection request is approved as revised by ACF on 07/27/01.
  Inventory as of this Action Requested Previously Approved
07/31/2004 07/31/2004
216 0 0
4,320 0 0
0 0 0

The purpose of this collection is to obtain data upon which to base the computation for measuring State performance in meeting the legislative goals of TANF as specified in section 403(a)(4) of the Social Security Act and 45 CFR Part 270. Specifically, DHHS will use the data to award th eportion of the Bonus that rewards States for their success in providing Medicaid and SCHIP work supports. Respondents may include any of the 50 States, DC, Guam, Puerto Rico, and the Virgin Islands.

None
None


No

1
IC Title Form No. Form Name
TANF High Performance Bonus Report, Assessment of Medicaid and SCHIP Enrollment Among Individuals After Leaving TANF Assistance ACF-210

  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 216 0 0 216 0 0
Annual Time Burden (Hours) 4,320 0 0 4,320 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.
05/24/2001


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