Limitations on Provider Related Donations and Health Care Related Taxes, etc. (CMS-R-148)

ICR 201104-0938-007

OMB: 0938-0618

Federal Form Document

Forms and Documents
Document
Name
Status
Supporting Statement A
2011-08-10
IC Document Collections
ICR Details
0938-0618 201104-0938-007
Historical Active 200804-0938-002
HHS/CMS
Limitations on Provider Related Donations and Health Care Related Taxes, etc. (CMS-R-148)
Extension without change of a currently approved collection   No
Regular
Approved with change 08/10/2011
Retrieve Notice of Action (NOA) 04/27/2011
  Inventory as of this Action Requested Previously Approved
08/31/2014 36 Months From Approved 08/31/2011
40 0 40
3,200 0 3,200
0 0 0

This information collection is necessary to ensure compliance with Sections 1903 and 1923 of the Social Security Act for the purpose of preventing payment of FFP on amounts prohibited by statute.

US Code: 42 USC 433 Name of Law: .68
   US Code: 42 USC 433. Name of Law: 74
   US Code: 42 USC 433 Name of Law: 272
  
None

Not associated with rulemaking

  76 FR 3909 01/21/2011
76 FR 18223 04/01/2011
No

1
IC Title Form No. Form Name
Limitations on Provider Related Donations and Health Care Related Taxes, etc.

  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 40 40 0 0 0 0
Annual Time Burden (Hours) 3,200 3,200 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
No
No
No
Uncollected
Mitch Bryman 410 786-5258 [email protected]

  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.
04/27/2011


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