IRS/SSA/CMS Data Match and Supporting Regulations in 42 CFR Sections 411.20-411.206

ICR 200901-0938-009

OMB: 0938-0565

Federal Form Document

Forms and Documents
ICR Details
0938-0565 200901-0938-009
Historical Active 200510-0938-013
HHS/CMS
IRS/SSA/CMS Data Match and Supporting Regulations in 42 CFR Sections 411.20-411.206
Extension without change of a currently approved collection   No
Regular
Approved without change 03/10/2009
Retrieve Notice of Action (NOA) 01/30/2009
  Inventory as of this Action Requested Previously Approved
03/31/2012 36 Months From Approved 03/31/2009
326,597 0 341,065
1,900,795 0 1,986,810
0 0 0

Employers identified through a match of IRS, SSA and Medicare records will be contacted concerning group health plan coverage of identified individuals to ensure compliance with Medicare Secondary Payer provisions found at 42 USC 1395y(b).

US Code: 42 USC 1395y(b) Name of Law: Exclusions from Coverage and Medicare Secondary Payer
  
None

Not associated with rulemaking

  73 FR 62997 10/22/2008
74 FR 902 01/09/2009
No

1
IC Title Form No. Form Name
IRS/SSA/CMS Data Match and Supporting Regulations in 42 CFR Sections 411.20-411.206 CMS-R-137 Data Match 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 326,597 341,065 0 0 -14,468 0
Annual Time Burden (Hours) 1,900,795 1,986,810 0 0 -86,015 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$16,300,000
No
No
Uncollected
Uncollected
Uncollected
Uncollected
William Parham 4107864669

  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.
01/30/2009


© 2024 OMB.report | Privacy Policy