Medicaid Statistical Information System (CMS-R-284)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
mmalaw.doc	Supplementary Document	Uploaded 2007-01-09	Available
bbalaw.doc	Supplementary Document	Uploaded 2007-01-09	Available
PUBLIC LAW 104-hipaa.doc	Supplementary Document	Uploaded 2007-01-09	Available
NPI-final rule.pdf	Supplementary Document	Uploaded 2007-01-09	Available
MSIS SS- CMS-R-284.docx	Supporting Statement A	Uploaded 2009-10-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
7980	Medicaid Statistical Information System (CMS-R-284)	Other-Other	Modified

ICR Details

OMB Control No: 0938-0345	ICR Reference No: 200911-0938-001
Status: Historical Active	Previous ICR Reference No: 200702-0938-001
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicaid Statistical Information System (CMS-R-284)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/30/2009
	Date Received in OIRA: 11/04/2009
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2012	36 Months From Approved	03/31/2010
Responses	204	0	212
Time Burden (Hours)	2,040	0	2,544
Cost Burden (Dollars)	0	0	0

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Abstract: State data are reported by the Federally mandated electronic process, known as MSIS (Medicaid Statistical Information System). These data are the basis of actuarial forecasts for Medicaid service utilization and costs; of analysis and cost savings estimates required for legislative initiatives relating to Medicaid and for responding to requests for information from CMS components, the Department,Congress and other customers.

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Authorizing Statute(s): PL: Pub.L. 108 - 173 103 Name of Law: MMA
   US Code: 42 USC 1935 Name of Law: Medicare Prescription Drugs
   PL: Pub.L. 105 - 32 4753 Name of Law: BBA
   US Code: 42 USC 1396b(r) Name of Law: MMIS
   US Code: 42 USC 1301 Name of Law: HIPAA Law
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AH99	Final or interim final rulemaking	69 FR 3434	01/23/2004

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 41142	08/14/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 54823	10/23/2009
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
Medicaid Statistical Information System (CMS-R-284)

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ICR Summary of Burden

table that charts list of burden

	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	204	212	0	-8	0	0
Annual Time Burden (Hours)	2,040	2,544	0	-504	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The decrease in burden is due to the exclusion of the Virgin Islands and Puerto Rico as they do not have an MMIS system and are not required to participate.

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Annual Cost to Federal Government: $225,000

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)? No

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: 11/04/2009

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