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OMB Control No: 0938-0193	ICR Reference No: 198110-0938-001
Status: Historical Active	Previous ICR Reference No: 198109-0938-004
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: AMENDMENT TO STATE PLAN, REGULATION "FREEDOM OF CHOICE: WAIVERS AND EXCEPTIONS TO STATE PLAN RESTRICTIONS
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: 10/25/1981
	Date Received in OIRA: 10/13/1981
Terms of Clearance: HCFA has submitted , for OMB approval, State Medicaid Plan amendments designed to implement each of the three following October 1,1981 regulations: 1. MIscellaneous Medicaid Provisions 2. Freedom of Choice 3. PSRO Technical Amendments Item no. 1 is approved as submitted. Item no. 2 is approved strictly as a certification. The second paragraph of p.4.10, requesting a report, will be deleted. Item no.3 is not approved. The parent regulation (section 431.630 (b)) should be changed so that only assurances are required for items (1), (2) and (4). Item (3) is acceptable in its present form.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/1983	09/30/1983	09/30/1983
Responses	702	0	648
Time Burden (Hours)	1,290	0	1,236
Cost Burden (Dollars)	0	0	0

Abstract: THIS "FREEDOM OF CHOICE" AMENDMENT REQUIRES STATES TO REPORT ON COMPETIVE BIDDING ARRANGEMENTS, RESTRICTIONS ON RECIPIENTS AND PROVIDERS AND TO SUBMIT REQUESTS FOR WAIVER OF STATE PLAN REQUIREMENTS

Authorizing Statute(s): None

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

Federal Register Notices & Comments
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
AMENDMENT TO STATE PLAN, REGULATION "FREEDOM OF CHOICE: WAIVERS AND EXCEPTIONS TO STATE PLAN RESTRICTIONS	HCFA-179

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	702	648	54
Annual Time Burden (Hours)	1,290	1,236	54
Annual Cost Burden (Dollars)	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:

Annual Cost to Federal Government: $0

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)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

View ICR - OIRA Conclusion