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Federal forms, ICRs, and supporting documents

Information Collection Request

QUALITY CONTROL NEGATIVE CASE ACTION WORKSHEET/REVIEW SCHEDULE - TABLE 1

ICR 198703-0970-010 · OMB 0970-0006 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
115754 QUALITY CONTROL NEGATIVE CASE ACTION WORKSHEET/REVIEW SCHEDULE - TABLE 1 Form Migrated
ICR Details
0970-0006 198703-0970-010
Historical Active 198508-0960-041
HHS/ACF
QUALITY CONTROL NEGATIVE CASE ACTION WORKSHEET/REVIEW SCHEDULE - TABLE 1
Revision of a currently approved collection   No
Regular
Approved without change 03/24/1987
Retrieve Notice of Action (NOA) 03/24/1987
  Inventory as of this Action Requested Previously Approved
03/31/1987 03/31/1987
22,000 0 0
22,000 0 0
0 0 0
THE QC NEGATIVE CASE ACTION REVIEW PROMOTES PROPER STATE ADMINISTRATIO OF THEIR AFDC, ADULT AND MEDICAID PROGRAMS BY HELPING TO ASSESS PERFORMANCE IN THE DENIAL OR TERMINATION OF BENEFITS. THE STATE COMPLETES FORM SSA-6401 (WORKSHEET/REVIEW SCHEDULE) FOR EACH CASE IN THE SAMPLE. THE COMPLETED FORM IS RETAINED IN THE STATE OFFICE. AFTE EACH REVIEW PERIOD, THE STATE COMPLETES AND SENDS TO THE FEDERAL GOVERNMENT A SUMMARY OF THE DATA ON STATISTICAL TABLE 1.
None
None
No
1
IC Title Form No. Form Name
QUALITY CONTROL NEGATIVE CASE ACTION WORKSHEET/REVIEW SCHEDULE - TABLE 1 SSA-6401
  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 22,000 0 0 0 22,000 0
Annual Time Burden (Hours) 22,000 0 0 0 22,000 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.
03/24/1987