OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Medicare Subsidy Quality Review Case Analysis, 20 CFR 418(b)(5)

ICR 200708-0960-007 · OMB 0960-0707 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form SSA-9314 Notice of Quality Review Acknowledgement Form for those without Phones Form and Instruction New Repair queued
Form SSA-9313 Notice of Quality Review Acknowledgement Form for those with Phones Form and Instruction New Repair queued
Form SSA-8510 SSA-8510 Form and Instruction Modified Repair queued
Form SSA-9310 SSA-9310 Form and Instruction Modified Repair queued
Form SSA-9309 SSA-9309 Form and Instruction Modified Available
Form SSA-9308 SSA-9308 Form and Instruction Modified Repair queued
Form SSA-9312 SSA-9312 Form and Instruction Modified Repair queued
Form SSA-9311 SSA-9311 Form and Instruction Modified Repair queued
Form SSA-9303 SSA-9303 Form and Instruction Modified Repair queued
Form SSA-9302 SSA-9302 Form and Instruction Modified Available
(2007) 0960-0707 supporting statement.doc Supporting Statement A Uploaded 2007-09-17 Available
IC Document Collections
IC IDCollectionTypeStatusForm
9763 SSA-9301 Other-Telephone Interview Script Modified
182005 Notice of Quality Review Acknowledgement Form for those without Phones Form and Instruction New
182004 Notice of Quality Review Acknowledgement Form for those with Phones Form and Instruction New
179417 SSA-8510 Form and Instruction Modified
179416 SSA-9310 Form and Instruction Modified
179415 SSA-9309 Form and Instruction Modified
179414 SSA-9308 Form and Instruction Modified
179412 SSA-9312 Form and Instruction Modified
179411 SSA-9311 Form and Instruction Modified
179409 SSA-9303 Form and Instruction Modified
179406 SSA-9302 Form and Instruction Modified
ICR Details
0960-0707 200708-0960-007
Historical Active 200704-0960-001
SSA
Medicare Subsidy Quality Review Case Analysis, 20 CFR 418(b)(5)
Revision of a currently approved collection   No
Regular
Approved with change 11/02/2007
Retrieve Notice of Action (NOA) 09/18/2007
This ICR is approved consistent with revisions made to forms SSA-9313 and SSA-9314. This ICR is also approved on the understanding that none of the other ICs in this collection are being modified from what was previously approved. Therefore, previous terms of clearance remain in effect.
  Inventory as of this Action Requested Previously Approved
11/30/2010 36 Months From Approved 04/30/2009
74,500 0 69,500
18,625 0 17,375
0 0 0
To validate its Medicare Part D subsidy determinations, SSA uses the Medicare Subsidy Quality Review Case Analysis system, in which it calls selected applicants and insurance/other companies to confirm certain information reported on form SSA-1020 (OMB No. 0960-0696). This submission is for two new forms SSA will use to conduct quality reviews with beneficiaries who recently underwent a Medicare Part D subsidy redetermination. The respondents are applicants for and recipients of the Medicare Part D subsidy information, insurance companies, and other third parties.
US Code: 42 USC 1395w-114 Name of Law: null
  
None
Not associated with rulemaking
  72 FR 28543 05/21/2007
72 FR 52594 09/14/2007
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 74,500 69,500 0 5,000 0 0
Annual Time Burden (Hours) 18,625 17,375 0 1,250 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
The burden for this ICR is increasing due to the addition of two new forms.
$507,213
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Elizabeth Davidson 411-965-0454 [email protected]
  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.
09/18/2007