Certification/Recertification Application

State Medicaid Fraud Control Units Annual Report and Recertification Application

OMB: 0990-0162

IC ID: 181665

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Information Collection (IC) Details

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Certification/Recertification Application
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 1007.15

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

Law Enforcement Criminal Investigation and Surveillance

 

50 0
   
State, Local, and Tribal Governments
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 50 0 0 0 0 50
Annual IC Time Burden (Hours) 250 0 0 0 0 250
Annual IC Cost Burden (Dollars) 0 0 0 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.

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