Information Collection Request

State Medicaid Fraud Control Units Annual Report and Recertification Application

ICR 201401-0990-001 · OMB 0990-0162 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
20694_ID 0990-0162 OIG Supporting Statement 2014rev 01-08-2014.docx Supporting Statement A Uploaded 2014-01-08 Available

IC Document Collections

ICR Details

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table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2017 36 Months From Approved 03/31/2014
113 0 100
4,663 0 4,650
0 0 0





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table that charts list of burden
IC Title Form No. Form Name
State Medicaid Fraud Control Units Annual Report and Recertification Application
Certification/Recertification Application
Annual Report, data mining reporting only

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 113 100 0 13 0 0
Annual Time Burden (Hours) 4,663 4,650 0 13 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


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