OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

COOPERATION REQUIRED OF AFDC APPLICANTS AND RECIPIENTS IN PURSUING THIRD PARTIES WHO MAY BE LIABLE TO PAY FOR TITLE XIX CARE AND SERVICES

ICR 199103-0970-001 · OMB 0970-0113 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
116001 COOPERATION REQUIRED OF AFDC APPLICANTS AND RECIPIENTS IN PURSUING THIRD PARTIES WHO MAY BE LIABLE TO PAY FOR TITLE XIX CARE AND SERVICES Migrated
ICR Details
0970-0113 199103-0970-001
Historical Active
HHS/ACF
COOPERATION REQUIRED OF AFDC APPLICANTS AND RECIPIENTS IN PURSUING THIRD PARTIES WHO MAY BE LIABLE TO PAY FOR TITLE XIX CARE AND SERVICES
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 06/03/1991
Retrieve Notice of Action (NOA) 03/28/1991
This information collection is approved through 5-94 under the following conditions: ACF must ensure that this collection is not duplicative with other existing secondary payor efforts.
  Inventory as of this Action Requested Previously Approved
05/31/1994 05/31/1994
3,200,000 0 0
533,000 0 0
0 0 0
THE FAMILY SUPPORT ADMINISTRATION WILL USE THE DATA COLLECTED UNDER 45 CFR 232, 234, AND 235 TO ASSIST STATES IN PURSUING ANY THIRD PARTY WHO MAY BE LIABLE TO PAY FOR MEDICAL ASSISTANCE UNDER TITLE XIX.
None
None
No
  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 3,200,000 0 0 3,200,000 0 0
Annual Time Burden (Hours) 533,000 0 0 533,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
03/28/1991