Limitations on Provider Related Donations and Health Care Related Taxes; Limitation on payments to Disproportionate Share Hospitals; Medicaid and Supporting Regulations in 42 CFR 433.68,.
ICR 200111-0938-002
OMB: 0938-0618
Federal Form Document
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-0618 can be found here:
Limitations on Provider
Related Donations and Health Care Related Taxes; Limitation on
payments to Disproportionate Share Hospitals; Medicaid and
Supporting Regulations in 42 CFR 433.68,.
Extension without change of a currently approved collection
This information
collection request is approved consistent with the following term
of clearance: CMS will ensure that the OMB number, expiration date
and PRA burden statement are displayed on any guidance documents
issued to respondents in conjunction with this collection.
Inventory as of this Action
Requested
Previously Approved
01/31/2005
01/31/2005
01/31/2002
40
0
40
2,880
0
2,880
0
0
0
This information collection is
necessary to ensure compliance with Sections 1903 and 1923 of the
Social Security Act for the purpose of preventing payment of FFP on
amounts prohibited by statute.
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.