OMB control number
State Supplementation Provisions: Agreements; Payments
OMB 0960-0240 · SSA.
SSA collects the pass-along increase information from each state agency that: (1) administers a state supplementary program; and (2) has agreed to comply with the provisions of the Act. The information we request allows SSA to determine each state's compliance or noncompliance with the pass-along requirements of the Act. Federal participation in the state's Medicaid program, under Title XIX of the Act, is dependent upon SSA’s determination of a state's compliance. States report supplementary payment information annually (for states complying by the maintenance of payment levels method). SSA may ask them to report up to four times per year (for states complying by the total-expenditures method). This collection asks respondents (i.e., states) to confirm their compliance with the pass along requirements, and to provide any changes to their optional supplementary payment rates. The respondents are state agencies administering supplementary income payment programs.
The latest form for State Supplementation Provisions: Agreements; Payments expires 2027-11-30 and can be found here.
Document Name |
|---|
Supporting Statement A |
Total Expenditures
Federal Enterprise Architecture: Income Security - General Retirement and Disability