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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0938-0993
ICR Reference No:
200910-0938-013
Status:
Historical Active
Previous ICR Reference No:
200706-0938-001
Agency/Subagency:
HHS/CMS
Agency Tracking No:
Title:
State Plan preprints to implement Sections of the Deficit Reduction Act of 2006 (CMS-10190)
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
12/30/2009
Retrieve Notice of Action (NOA)
Date Received in OIRA:
10/27/2009
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
12/31/2012
36 Months From Approved
12/31/2009
Responses
4,016
0
4,056
Time Burden (Hours)
699
0
723
Cost Burden (Dollars)
0
0
0
Abstract:
The DRA provides states with flexibility to request through the use of State Plan preprints changes in benefit packages, cost-sharing, non-emergency medical transportation services etc. CMS will send State Medicaid Directors letters and State Plan preprints to States in an effort to request these changes. The information collected from the State will be reviewed and approved by CMS in order that States can implement the Medicaid program.
Authorizing Statute(s):
Statute at Large:
19 Stat. 1901
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
74 FR 41142
08/14/2009
30-day Notice:
Federal Register Citation:
Citation Date:
74 FR 54823
10/23/2009
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
2
IC Title
Form No.
Form Name
State Plan preprints to Implement Sections of the Deficit Reduction Act of 2006 and Third-party Disclosure for Non-emergencies
CMS-10190
6043 Costsharing Preprint
State Plan preprints to implement Sections of the Deficit Reduction Act of 2006 and Third-party Disclosure for Non-emergencies (CMS-10190)
CMS-10190, CMS-10190, CMS-10190, CMS-10190, CMS-10190
DRA 6041 Costsharing Preprint
,
DRA 6042 costsharing preprint
,
nem3 1d
,
Non-Emergency Medical Transportation preprint
,
6044 Benchmark Preprint
ICR Summary 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
4,016
4,056
0
-40
0
0
Annual Time Burden (Hours)
699
723
0
-24
0
0
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:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
Burden slightly decreased due to fewer States submitting templates annually.
Annual Cost to Federal Government:
$4,665
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
Uncollected
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
Uncollected
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Melissa Musotto 4107866962
Common Form ICR:
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:
(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:
10/27/2009
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