State Medicaid Eligibility Quality Control Sampling Plan (CMS-317)

Forms and Documents

Document Name	Status
Supporting Statement Part B.docx Supporting Statement B	2020-11-12
CMS 317 - Supporting Statement Part A 30day.docx Supporting Statement A	2020-11-12

IC Document Collections

IC ID	Document Title	Status
43651	State Medicaid Eligibility Quality Control Sampling Plan	Modified

ICR Details

OMB Control No: 0938-0146	ICR Reference No: 202011-0938-006
Status: Received in OIRA	Previous ICR Reference No: 201609-0938-015
Agency/Subagency: HHS/CMS	Agency Tracking No: 20377
Title: State Medicaid Eligibility Quality Control Sampling Plan (CMS-317)
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 11/13/2020

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	20	0
Time Burden (Hours)	520	0
Cost Burden (Dollars)	0	0

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Abstract: State Title XIX agencies are required to submit sampling plan revisions 60 days prior to the corresponding review period and universe estimates and sampling intervals two weeks prior to the first selection of the review period. CMS or its contractors reviews the plans to ensure States are using valid statistical methods for sample selection.

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Authorizing Statute(s): US Code: 42 USC 1396b Name of Law: Payment to States
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 31511	05/26/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 66993	10/21/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
State Medicaid Eligibility Quality Control Sampling Plan

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ICR Summary of Burden

	Total Request	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	20	0	0	0	0	20
Annual Time Burden (Hours)	520	0	0	0	40	480
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The increase from an average of 48 to 52 hours per state is based on estimates from those states on CMS’s MEQC State Advisory Committee that have already prepared and submitted MEQC pilot planning documents and gone through the approval process. States are currently required to submit their MEQC pilot planning documents electronically to a specially designated MEQC mailbox.

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Annual Cost to Federal Government: $291,360

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 11/13/2020

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