OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 199401-0970-004 · OMB 0970-0072 · Historical Active

Forms and Documents
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IC Document Collections
IC IDCollectionTypeStatusForm
115935 WORKSHEET FOR INTEGRATED AFDC, ADULT, FOOD STAMPS, AND MEDICAID ELIGIBILITY QUALITY CONTROL REVIEWS Form Migrated
ICR Details
0970-0072 199401-0970-004
Historical Active 199102-0970-002
HHS/ACF
WORKSHEET FOR INTEGRATED AFDC, ADULT, FOOD STAMPS, AND MEDICAID ELIGIBILITY QUALITY CONTROL REVIEWS
Revision of a currently approved collection   No
Regular
Approved without change 03/28/1994
Retrieve Notice of Action (NOA) 01/27/1994
  Inventory as of this Action Requested Previously Approved
03/31/1997 03/31/1997 03/31/1994
59,500 0 63,000
655,904 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 AND JURISDICTIONS FOR THE AFD ADULT, FOOD STAMP, AND MEDICAID PROGRAMS. THE FINDINGS ARE USED TO IDENTIFY AREAS WHERE ACTION IS NEEDED.
None
None
No
1
IC Title Form No. Form Name
WORKSHEET FOR INTEGRATED AFDC, ADULT, FOOD STAMPS, AND MEDICAID ELIGIBILITY QUALITY CONTROL REVIEWS ACF 4340
  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 59,500 63,000 0 0 -3,500 0
Annual Time Burden (Hours) 655,904 694,487 0 0 -38,583 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.
01/27/1994