OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Social Security Office (SSO) Report of State Buy-in Problems

ICR 200606-0938-006 · 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
7787 Social Security Office (SSO) Report of State Buy-in Problems Form Migrated
ICR Details
0938-0035 200606-0938-006
Historical Active 200305-0938-003
HHS/CMS
Social Security Office (SSO) Report of State Buy-in Problems
Extension without change of a currently approved collection   No
Regular
Approved without change 07/06/2006
Retrieve Notice of Action (NOA) 06/21/2006
  Inventory as of this Action Requested Previously Approved
07/31/2009 07/31/2009 07/31/2006
6,600 0 3,000
2,366 0 1,075
0 0 0
The CMS-1957 is issued to facilitate communications among the Social Security District Offices, Medicaid State Agencies and CMS Central Office in the resolution of beneficiary entitlement under State Buy-in. It's used when a problem arises which cannot be resolved through the normal data exchange.
None
None
No
1
IC Title Form No. Form Name
Social Security Office (SSO) Report of State Buy-in Problems CMS-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 6,600 3,000 0 0 3,600 0
Annual Time Burden (Hours) 2,366 1,075 0 0 1,291 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.
06/21/2006