Medicare Waiver Demonstration Application

ICR 200707-0938-006

OMB: 0938-0880

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supporting Statement A
2007-06-13
IC Document Collections
ICR Details
0938-0880 200707-0938-006
Historical Active 200606-0938-012
HHS/CMS
Medicare Waiver Demonstration Application
Extension without change of a currently approved collection   No
Regular
Approved without change 11/30/2007
Retrieve Notice of Action (NOA) 07/13/2007
  Inventory as of this Action Requested Previously Approved
11/30/2010 36 Months From Approved 11/30/2007
75 0 75
6,000 0 6,000
0 0 0

This application provides an opportunity for eligible organizations to apply to participate in Medicare-waiver-only demonstrations sponsored by the Centers for Medicare & Medicaid Services (CMS). CMS conducts Medicare-waiver-only demonstrations to test innovations that have been shown to be successful in improving access and quality and/or lowering health care costs.

US Code: 42 USC 1395B-1 Name of Law: Incentives for economy while maintaining or improving quality in provision of health services.
   PL: Pub.L. 92 - 603 402 Name of Law: Incentives for Economy While Maintaining or Improving Quality in the Provision of Health Services
  
None

Not associated with rulemaking

  72 FR 13793 03/23/2007
72 FR 31840 06/08/2007
No

1
IC Title Form No. Form Name
Medicare Waiver Demonstration Application CMS-10069 Medicare Waiver Demonstration Application & Instructions

  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 75 75 0 0 0 0
Annual Time Burden (Hours) 6,000 6,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$44,400
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Bonnie Harkless 4107865666

  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.
07/13/2007


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