State Medicaid Eligibility Quality Control Sampling Plan

ICR 200607-0938-009

OMB: 0938-0146

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
0938-0146 200607-0938-009
Historical Active 200211-0938-001
HHS/CMS
State Medicaid Eligibility Quality Control Sampling Plan
Extension without change of a currently approved collection   No
Regular
Approved without change 10/16/2006
Retrieve Notice of Action (NOA) 07/12/2006
  Inventory as of this Action Requested Previously Approved
10/31/2009 36 Months From Approved 10/31/2006
20 0 110
480 0 2,640
0 0 0

The State MEQC sampling plan is necessary for CMS to monitor the States# operation of the MEQC system for States performing the traditional sampling process. The sampling plan includes all data involved in the States# sample selection process - population sizes and sample frame lists, sample sizes, sample selection procedures, and claim collection procedures.

None
None


No

1
IC Title Form No. Form Name
State Medicaid Eligibility Quality Control Sampling Plan CMS-317

  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 20 110 0 0 -90 0
Annual Time Burden (Hours) 480 2,640 0 0 -2,160 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
Yes Part B of Supporting Statement
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.
07/12/2006


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