View Information Collection Request (ICR) Package
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Common Form Info.
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View Information Collection (IC) List
View Supporting Statement and Other Documents
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:
0938-1012
ICR Reference No:
200908-0938-004
Status:
Historical Active
Previous ICR Reference No:
200810-0938-006
Agency/Subagency:
HHS/CMS
Agency Tracking No:
Title:
Payment Error Rate Measurement - State Medicaid and CHIP Eligibility
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Emergency
Approval Requested By:
08/21/2009
OIRA Conclusion Action:
Approved without change
Conclusion Date:
08/18/2009
Retrieve Notice of Action (NOA)
Date Received in OIRA:
08/12/2009
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
02/28/2010
01/31/2010
01/31/2010
Responses
1,379
0
1,360
Time Burden (Hours)
942,764
0
535,670
Cost Burden (Dollars)
0
0
0
Abstract:
The Improper Payments Information Act (IPIA) of 2002 requires CMS to produce national error rates for Medicaid and SCHIP. To comply with the IPIA, CMS needs the information to be collected in order to provide some Federal overview of state eligibility determinations to ensure correctness and consistency among states and to use the State-specific error rates as the basis for calculating national eligibility error rates for Medicaid and SCHIP.
Emergency Justfication:
See Attached Emergency Justification that was approved by OMB.
Authorizing Statute(s):
PL:
Pub.L. 107 - 300 2
Name of Law: The Improper Payments Information Act of 2002
Citations for New Statutory Requirements:
PL: Pub.L. 111 - 3 601 Name of Law: Children's Health Insurance Program Reauthorization Act of 2009
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
30-day Notice:
Federal Register Citation:
Citation Date:
74 FR 36718
07/24/2009
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
8
IC Title
Form No.
Form Name
Payment Error Rate Measurement - State Medicaid and CHIP Eligibility
CMS-10184
CMS-10184.FINAL-PERM Eligibility Error Rate Forms
Payment Error Rate Measurement - State Medicaid and CHIP Eligibility
CMS-10184
CMS-10184.FINAL-PERM Eligibility Error Rate Forms
Payment Error Rate Measurement - State Medicaid and CHIP Eligibility
CMS-10184
CMS-10184.FINAL-PERM Eligibility Error Rate Forms
Payment Error Rate Measurement - State Medicaid and CHIP Eligibility
CMS-10184
CMS-10184.FINAL-PERM Eligibility Error Rate Forms
Payment Error Rate Measurement - State Medicaid and CHIP Eligibility
CMS-10184
CMS-10184.FINAL-PERM Eligibility Error Rate Forms
Payment Error Rate Measurement - State Medicaid and CHIP Eligibility
CMS-10184
CMS-10184.FINAL-PERM Eligibility Error Rate Forms
Payment Error Rate Measurement - State Medicaid and CHIP Eligibility
CMS-10184
CMS-10184.FINAL-PERM Eligibility Error Rate Forms
Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (MEQC Substitution)
CMS-10184D, CMS-10184A, CMS-10184B, CMS-10184E
Detailed Payment Review Findings
,
Cases Selected for Review: Monthly Sample Selection List
,
Detailed Active Case Review Findings
,
Summary Findings
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
1,379
1,360
19
0
0
0
Annual Time Burden (Hours)
942,764
535,670
407,094
0
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:
No
Burden Reduction Due to:
Short Statement:
Please see the attached supporting statement.
Annual Cost to Federal Government:
$0
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
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:
William Parham 4107864669
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:
08/12/2009
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