View Information Collection Request (ICR) Package

OMB Control No: 0938-0193	ICR Reference No: 201203-0938-014
Status: Historical Active	Previous ICR Reference No: 200902-0938-006
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: State Plan Under Title XIX of the Social Security Act (Base plan pages, Attachments, Supplements to Attachments)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/26/2012
	Date Received in OIRA: 03/29/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2015	36 Months From Approved	07/31/2012
Responses	1,120	0	4,681
Time Burden (Hours)	22,400	0	9,271
Cost Burden (Dollars)	0	0	0

Abstract: The Medicaid State base plan pages and attachments are documents utilized by State and territorial agencies which have the responsibility for administering the Medicaid program. The Medicaid State plan is comprised of "pages" and organized by subject matter which include Medicaid eligibility (Section 2), services (Section 3), payment for services (Section 4), and general, financial and personnel administration (Sections 1, 5, 6, 7). When States or territories seek to change selected pages of their State plans, the page(s) are transmitted to the Centers for Medicare & Medicaid Services (CMS) for review and approval by the CMS Central and Regional Offices prior to amending its State plan. Associated with the "CMS-179", a one page cover page that is included in every State plan amendment, the base State plan pages contain approximately 150 documents, and the Attachments and Supplements contain approximately 500 documents that correspond to implementing regulations in the CFR and statutes in the Social Security Act. The base and plan page documents have the same OMB approval number as the CMS-179. The present revision of the current collection is to revise and update selected pages to comply with Federal laws and regulations.

Authorizing Statute(s): US Code: 42 USC 1936 Name of Law: Social Security Act

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:
	76 FR 78264	12/16/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 17068	03/23/2012
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
State Plan Under Title XIX of the Social Security Act (Base plan pages)	CMS-179

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion	Change Due to Adjustment in Estimate
Annual Number of Responses	1,120	4,681	0	-3,561
Annual Time Burden (Hours)	22,400	9,271	21	13,108
Annual Cost Burden (Dollars)	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: The Supporting Statement associated with the prior PRA approval indicated that States submit on average 84 SPAs per year (4,681 responses / 56 States). We are revising this estimate to indicate that each State submits on average 20 SPAs per year. The prior Supporting Statement also indicated that States required approximately 1 hour "per page" to complete a SPA submission. We are revising this estimate to indicate that States require approximately 20 hours "per SPA submission" to complete the template, receive necessary State clearance, and submit the template to CMS. Within this package, templates corresponding with sections 4.19(c), 4.19-D, and 4.19.B have been revised while templates corresponding with sections 4.19(e), 4.19(f), 4.19(g), 4.19(h), 4.19(i), and 4.19(k)(1) are added.

Annual Cost to Federal Government: $168,000

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]? 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? Uncollected

Agency Contact: Mitch Bryman 410 786-5258 Mitch.Bryman@cms.hhs.gov

View ICR - OIRA Conclusion