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Medicaid - Determining Third Party Liability (TPL) State Plan Preprint and Supporting Regulation in 42 CFR 433.138
Medicaid - Determining Third Party Liability (TPL) State Plan Preprint and Supporting Regulation in 42 CFR 433.138 (CMS-R-107)
OMB: 0938-0502
IC ID: 8123
OMB.report
HHS/CMS
OMB 0938-0502
ICR 200903-0938-010
IC 8123
( )
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
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IC Title:
Medicaid - Determining Third Party Liability (TPL) State Plan Preprint and Supporting Regulation in 42 CFR 433.138
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
42 CFR 433.138
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
2,900,000
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
2,900,000
0
0
200,000
0
2,700,000
Annual IC Time Burden (Hours)
510,968
0
0
38,709
0
472,259
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.