Managed Care Data Using the Uniform Institutional Providers Form

ICR 200108-0938-005

OMB: 0938-0711

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-0711 200108-0938-005
Historical Active 199909-0938-013
HHS/CMS
Managed Care Data Using the Uniform Institutional Providers Form
Extension without change of a currently approved collection   No
Regular
Approved without change 10/29/2001
Retrieve Notice of Action (NOA) 08/23/2001
Approved for use for a short term through 1/2002 under the condition that the next submission to OMB fully responds to the enclosed public comment.
  Inventory as of this Action Requested Previously Approved
02/28/2002 02/28/2002 11/30/2001
1,353,500 0 1
6,533 0 6,547
0 0 0

HCFA continues to require hospital inpatient encounter data from Medicare + Choice organizations to develop and implement a risk adjustment payment methodology as requied by the Balanced Budget Act of 1997.

None
None


No

1
IC Title Form No. Form Name
Managed Care Data Using the Uniform Institutional Providers Form HCFA-R-224

  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 1,353,500 1 0 0 1,353,499 0
Annual Time Burden (Hours) 6,533 6,547 0 0 -14 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.
08/23/2001


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