STATISTICAL REPORT ON MEDICAL CARE: RECIPIENTS, PAYMENTS AND SERVICES

Forms and Documents

Document Name	Status

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

IC ID	Document Title	Status
113476	STATISTICAL REPORT ON MEDICAL CARE: RECIPIENTS, PAYMENTS AND SERVICES Form	Migrated

ICR Details

OMB Control No: 0938-0345	ICR Reference No: 198401-0938-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: STATISTICAL REPORT ON MEDICAL CARE: RECIPIENTS, PAYMENTS AND SERVICES
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/22/1984
	Date Received in OIRA: 01/31/1984
Terms of Clearance: THIS COLLECTION IS APPROVED AS FOLLOWS: 1. THE HARD COPY VERSION OF THE HCFA 2082 IS APPROVED FOR USE THRU APRIL 1985 BEGINNING WITH THE FY 1984 REPORTING PERIOD. THIS EXPIRA TION DATE MUST APPEAR ON THE PRINTED FORMS. HCFA SHALL ASSESS THIS TO DETERMINE THE CONTINUED UTILITY OF COLLECTING THIS OR OTHER DATA FOR PROGRAM MANAGEMENT OR POLICY MAKING PURPOSES. 2. THE MMIS TAPE SAMPLE VERSION OF THE HCFA 2082 IS APPROVED FOR USE THRU FEBRUARY 1987 BEGINNING WITH THE FY 1984 REPORTING PERIOD PROVIDING THE FOLLOWING CONDITIONS ARE MET: A. THE FINAL VERSION OF THE MMIS TAPE SAMPLE WITH A COMPILATION OF THE STATE COMMENTS IS SUBMITTED TO OMB FOR APPROVAL BY APRIL 9. B. THE FINAL VERSION OF THE MMIS TAPE SAMPLE AND INSTRUCTIONS ARE SENT TO MEDICAID STATE AGENCIES NO LATER THAN APRIL 16, 1984. C. DRAFTS OF THE FORMAL ACTION TRANSMITTAL AND MANUAL REVISIIONS ARE SUBMITTED TO OMB FOR APPROVAL BY JUNE 1, 1984, AND ARE MAILED TO STATE MEDICAID AGENCIES BY JUNE 15, 1984. 3. THE FY 1983 VERSION OF THE HCFA 2082 IS APPROVED FOR USE BY THOSE STATE MEDICAID AGENCIES WHICH ELECT TO REPORT VIA THE MMIS TAPE SAMPLE BUT ARE UNABLE TO DO SO FOR THE FY 1984 REPORTING PERIOD. 4. HCFA SHALL SUBMIT NEW BURDEN CALCULATIONS TO OMB BY JUNE 1, 1984.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/1987	02/28/1987
Responses	55	0	0
Time Burden (Hours)	21,039	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: THIS DATA IS NEEDED TO MONITOR PAST AND PROJECTED FUTURE TRENDS IN THE MEDICAID PROGRAM. IT IS USED AS THE BASIS OF THE ANALYSIS AND COST SAVING ESTIMATES FOR COST SHARING LEGISLATION INITIATIVES TO CONGRESS. ANOTHER IMPORTANT USE CENTERS ON HCFA'S/HHS ACTUARIAL FORECAST. THE RESPONDENTS ARE MEDICAID STATE AGENCIES.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
STATISTICAL REPORT ON MEDICAL CARE: RECIPIENTS, PAYMENTS AND SERVICES	HCFA-2082

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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	55	0	0	0	55	0
Annual Time Burden (Hours)	21,039	0	0	0	21,039	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:

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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

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Common Form ICR:  No

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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: 01/31/1984

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