Letter Requesting Waiver of Medicare/Medicaid Enrollment Application Fee; Submission of Fingerprints; Submission of Medicaid Identifying Information; Medicaid Site Visit and Rescreening
ICR 201010-0938-005
OMB: 0938-1137
Federal Form Document
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1137 can be found here:
Letter Requesting Waiver of
Medicare/Medicaid Enrollment Application Fee; Submission of
Fingerprints; Submission of Medicaid Identifying Information;
Medicaid Site Visit and Rescreening
New
collection (Request for a new OMB Control Number)
This OMB action
is not an approval to conduct or sponsor an information collection
under the Paperwork Reduction Act of 1995. This action has no
effect on any current approvals. If OMB has assigned this ICR a new
OMB Control Number, the OMB Control Number will not appear in the
active inventory. For future submissions of this information
collection, reference the OMB Control Number provided. In
accordance with 5 CFR 1320, the agency should resubmit this ICR at
the final rule stage.
Inventory as of this Action
Requested
Previously Approved
36 Months From Approved
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0
0
0
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On March 23, 2010, the President
signed into law H.R. 3590, the Patient Protection and Affordable
Care Act (Affordable Care Act), Public Law 111-148. Section 6401 of
the law establishes a number of important payment safeguard
provisions, several of which have been incorporated into CMS
Proposed Rule 6028, entitled "Medicare, Medicaid, and Children's
Health Insurance Programs (CHIP); Additional Screening
Requirements, Application Fees, Temporary Enrollment Moratoria,
Payment Suspensions and Compliance Plans for Providers and
Suppliers," and published in the Federal Register on September 23,
2010. The provisions are designed to improve the integrity of the
Medicare, Medicaid, and CHIP programs so as to reduce fraud, waste
and abuse.
PL:
Pub.L. 111 - 148 6401 Name of Law: Provider Screening and Other
Enrollment Requirements Under Medicare, Medicaid & CHIP
PL: Pub.L. 111 - 148 6401 Name of Law:
Provider Screening and Other Enrollment Requirements Under
Medicare, Medicaid & CHIP
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.
CMS-10357.Instrument Elements.doc
State Medicaid Agency Processing of Rescreening Application