Medicaid Statistical Information System (CMS-R-284)

Forms and Documents

Document Name	Status
CMS-R-284 supporting statement.doc Supporting Statement A	2007-02-01

IC Document Collections

IC ID	Document Title	Status
7980	Medicaid Statistical Information System (CMS-R-284) Other-Other	Modified

ICR Details

OMB Control No: 0938-0345	ICR Reference No: 200702-0938-001
Status: Historical Active	Previous ICR Reference No: 200605-0938-011
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicaid Statistical Information System (CMS-R-284)
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: 03/13/2007
	Date Received in OIRA: 02/01/2007
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2010	36 Months From Approved	06/30/2009
Responses	212	0	212
Time Burden (Hours)	2,544	0	2,120
Cost Burden (Dollars)	0	0	64,000

---

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. 105 - 32 4753 Name of Law: BBA
   PL: Pub.L. 108 - 173 103 Name of Law: MMA
   US Code: 42 USC 1935 Name of Law: Medicare Prescription Drugs
   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:
	71 FR 60532	10/13/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 78443	12/29/2006
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	212	212	0	0	0	0
Annual Time Burden (Hours)	2,544	2,120	0	424	0	0
Annual Cost Burden (Dollars)	0	64,000	0	-64,000	0	0

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

Burden Increase Due to: Changing Regulations

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

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The FY 2007 burden hours, as approved by OMB were 2,120, with no changes to the program. The burden time for 2007 will increase to 3,392 hours to allow for the start-up time to implement the NPI changes. For 2008 and 2009, the burden will drop down to 2,120 each year.

---

Annual Cost to Federal Government: $225

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

---

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: 02/01/2007

---