Medicare Subsidy Quality Review Case Analysis

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
OMB No 0960-0707-Medicare Quality Review System-Proposed Changes (12-19-06).doc	Justification for No Material/Nonsubstantive Change	Uploaded 2006-12-29	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
9763	Medicare Subsidy Quality Review Case Analysis	Instruction	Modified

ICR Details

OMB Control No: 0960-0707	ICR Reference No: 200612-0960-015
Status: Historical Inactive	Previous ICR Reference No: 200602-0960-007
Agency/Subagency: SSA	Agency Tracking No:
Title: Medicare Subsidy Quality Review Case Analysis
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 03/22/2007
	Date Received in OIRA: 12/29/2006
Terms of Clearance: This ICR is withdrawn per agency request.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2009	04/30/2009	04/30/2009
Responses	69,000	0	69,000
Time Burden (Hours)	17,249	0	17,249
Cost Burden (Dollars)	0	0	0

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Abstract: Original Abstract: To validate the Medicare Part P subsidy determinations it is making, SSA uses the Medicare Subsidy Quality Review Case Analysis system, in which it calls selected applicants and insurance/other companies to confirm certain information reported on form SSA-1020 (OMB No. 0960-0696). The respondents are applicants for the Medicare Part D subsidy information, insurance companies, and other third parties. NOTE on this change sheet request: In this change request, we are 1) submitting a list of nonsubstantive wording changes to several of the forms in the collection and 2) substituting two identical but differently titled notices that are more appropriate for the denied population. There is no change to the burden. The attached "supplementary" document lists and describes all the proposed changes. Please note that we submitted these changes to OMB on Tuesday, 12/19/06 via email since the ROCIS system was down on 12/19/06 and 12/20/06. This request is just a reiteration of that request.

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Authorizing Statute(s): PL: Pub.L. 108 - 173 1860 D-14(a)(3)(E)(iii)(III) Name of Law: Medicare Modernization Act of 2003
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Medicare Subsidy Quality Review Case Analysis	SSA-9301, SSA-9302, SSA-9303	Medicare Subsidy Quality Review Case Analysis ,   Notice of Appointment-Reviewer Will Call ,   Notice of Appointment-Please Call Reviewer

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Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 12/29/2006

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