Information Collection

State Medicaid Fraud Control Units Annual Report and Recertification Application

IC 10317 under ICR 201010-0990-003 · OMB 0990-0162.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0162 can be found here:

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Information Collection (IC) Details

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IC Title:	State Medicaid Fraud Control Units Annual Report and Recertification Application	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 1007.17

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Law Enforcement

Subfunction: Criminal Investigation and Surveillance

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	50	1	49
Annual IC Time Burden (Hours)	4,400	88	4,312
Annual IC Cost Burden (Dollars)	0	0	0

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.