OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

MEDICAID - SOCIAL SECURITY OFFICE (SSO) REPORT OF STATE BUY-IN PROBLEM

ICR 198604-0938-010 · OMB 0938-0035 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
112588 MEDICAID - SOCIAL SECURITY OFFICE (SSO) REPORT OF STATE BUY-IN PROBLEM Form Migrated
ICR Details
0938-0035 198604-0938-010
Historical Active 198304-0938-004
HHS/CMS
MEDICAID - SOCIAL SECURITY OFFICE (SSO) REPORT OF STATE BUY-IN PROBLEM
Revision of a currently approved collection   No
Regular
Approved without change 07/15/1986
Retrieve Notice of Action (NOA) 04/16/1986
  Inventory as of this Action Requested Previously Approved
07/31/1989 07/31/1989 05/31/1986
40,000 0 25,000
11,666 0 6,250
0 0 0
THE HCFA-1957 IS USED FOR COMMUNICATION AMONG THE SOCIAL SECURITY DISTRICT OFFICES, THE MEDICAID STATE AGENCIES, AND HCFA CENTRAL OFFICE IN THE RESOLUTION OF BENEFICIA COMPLAINTS REGARDING ENTITLEMENT UNDER STATE BUY-IN. IT IS USED WHEN A PROBLEM ARISES WHICH CANNOT BE RESOLVED THROUGH NORMAL DATA EXCHANGES.
None
None
No
1
IC Title Form No. Form Name
MEDICAID - SOCIAL SECURITY OFFICE (SSO) REPORT OF STATE BUY-IN PROBLEM HCFA-1957
  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 40,000 25,000 0 0 15,000 0
Annual Time Burden (Hours) 11,666 6,250 0 0 5,416 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
04/16/1986