OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

WORKSHEET FOR INTEGRATED AFDC, FOOD STAMPS AND MEDICAID QUALITY CONTROL REVIEWS

ICR 199005-0970-001 · OMB 0970-0072 · Historical Inactive

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
115932 WORKSHEET FOR INTEGRATED AFDC, FOOD STAMPS AND MEDICAID QUALITY CONTROL REVIEWS Form Migrated
ICR Details
0970-0072 199005-0970-001
Historical Inactive 198912-0970-004
HHS/ACF
WORKSHEET FOR INTEGRATED AFDC, FOOD STAMPS AND MEDICAID QUALITY CONTROL REVIEWS
Revision of a currently approved collection   No
Regular
Withdrawn and continue 06/05/1990
Retrieve Notice of Action (NOA) 05/14/1990
Withdrawn at the request of the agency. Previous terms of clearance still apply. The previous clearance is continued with the expiration date of 12/31/90.
  Inventory as of this Action Requested Previously Approved
12/31/1990 12/31/1990 12/31/1990
63,000 0 63,000
694,487 0 694,487
0 0 0
THE INTEGRATED WORKSHEET SERVES TO DOCUMENT THE FINDINGS OF STATE QUALITY CONTROL REVIEWERS WHO REVIEW THE CORRECTNESS OF A SAMPLE OF ELIGIBILITY DECISIONS MADE BY THE STATES FOR THE AFDC, FOOD STAMP AND MEDICAID PROGRAMS. THE FINDINGS ARE USED TO IDENTIFY AREAS WHERE CORRECTIVE ACTION IS NEEDED.
None
None
No
1
IC Title Form No. Form Name
WORKSHEET FOR INTEGRATED AFDC, FOOD STAMPS AND MEDICAID QUALITY CONTROL REVIEWS FSA-4340
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.
05/14/1990