Request for Accelerated Payments Supporting Regs in 42 CFR, section 412.116(f), 412.632(e), 413.64(g), 413.350(d) & 484.245

ICR 200812-0938-003

OMB: 0938-0269

Federal Form Document

Forms and Documents
Document
Name
Status
Supporting Statement A
2008-12-11
ICR Details
0938-0269 200812-0938-003
Historical Active 200512-0938-001
HHS/CMS
Request for Accelerated Payments Supporting Regs in 42 CFR, section 412.116(f), 412.632(e), 413.64(g), 413.350(d) & 484.245
Extension without change of a currently approved collection   No
Regular
Approved without change 02/02/2009
Retrieve Notice of Action (NOA) 12/17/2008
  Inventory as of this Action Requested Previously Approved
02/29/2012 36 Months From Approved 02/28/2009
880 0 822
440 0 411
0 0 0

These forms are used by fiscal intermediaries to assess a provider's eligibility for accelerated payments. Such a payment is granted if there is an unusual delay in processing bills.

US Code: 42 USC 412.116(f) Name of Law: null
   US Code: 42 USC 412.632(e) Name of Law: null
   US Code: 42 USC 413.64(g) Name of Law: null
   US Code: 42 USC 413.350(d) Name of Law: null
   US Code: 42 USC 484.245 Name of Law: null
  
None

Not associated with rulemaking

  73 FR 53027 09/12/2008
73 FR 72486 11/28/2008
No

  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 880 822 0 0 58 0
Annual Time Burden (Hours) 440 411 0 0 29 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$44,678
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.
12/17/2008


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