View Information Collection Request (ICR) Package
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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:
0938-0345
ICR Reference No:
200911-0938-001
Status:
Historical Active
Previous ICR Reference No:
200702-0938-001
Agency/Subagency:
HHS/CMS
Agency Tracking No:
Title:
Medicaid Statistical Information System (CMS-R-284)
Type of Information Collection:
Extension without change of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
11/30/2009
Retrieve Notice of Action (NOA)
Date Received in OIRA:
11/04/2009
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
11/30/2012
36 Months From Approved
03/31/2010
Responses
204
0
212
Time Burden (Hours)
2,040
0
2,544
Cost Burden (Dollars)
0
0
0
Abstract:
State data are reported by the Federally mandated electronic process, known as MSIS (Medicaid Statistical Information System). These data are the basis of actuarial forecasts for Medicaid service utilization and costs; of analysis and cost savings estimates required for legislative initiatives relating to Medicaid and for responding to requests for information from CMS components, the Department,Congress and other customers.
Authorizing Statute(s):
PL:
Pub.L. 108 - 173 103
Name of Law: MMA
US Code:
42 USC 1935
Name of Law: Medicare Prescription Drugs
PL:
Pub.L. 105 - 32 4753
Name of Law: BBA
US Code:
42 USC 1396b(r)
Name of Law: MMIS
US Code:
42 USC 1301
Name of Law: HIPAA Law
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
0938-AH99
Final or interim final rulemaking
69 FR 3434
01/23/2004
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:
1
IC Title
Form No.
Form Name
Medicaid Statistical Information System (CMS-R-284)
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
204
212
0
-8
0
0
Annual Time Burden (Hours)
2,040
2,544
0
-504
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:
The decrease in burden is due to the exclusion of the Virgin Islands and Puerto Rico as they do not have an MMIS system and are not required to participate.
Annual Cost to Federal Government:
$225,000
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:
11/04/2009
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