OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 201305-0938-008 · OMB 0938-0035 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form CMS-1957 Social Security Office (SSO) Report of State Buy-in Problems Form Modified Repair queued
Form CMS-1957 Social Security Office (SSO) Report of State Buy-in Problems Form Modified Repair queued
CMS-1957 Supporting Statement .pdf Supporting Statement A Uploaded 2013-05-15 Available
IC Document Collections
IC IDCollectionTypeStatusForm
7787 Social Security Office (SSO) Report of State Buy-in Problems Form Modified
191528 Social Security Office (SSO) Report of State Buy-in Problems Form Modified
ICR Details
0938-0035 201305-0938-008
Historical Active 200912-0938-004
HHS/CMS 19616
Social Security Office (SSO) Report of State Buy-in Problems
Reinstatement without change of a previously approved collection   No
Regular
Approved without change 09/20/2013
Retrieve Notice of Action (NOA) 05/16/2013
  Inventory as of this Action Requested Previously Approved
09/30/2016 36 Months From Approved
5,600 0 0
1,816 0 0
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.
US Code: 42 USC 1395v Name of Law: Agreements with States
  
None
Not associated with rulemaking
  78 FR 13678 02/28/2013
78 FR 27399 05/10/2013
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 5,600 0 0 0 0 5,600
Annual Time Burden (Hours) 1,816 0 0 0 0 1,816
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
No
No
No
No
Uncollected
Kayla Williams 410 786-5887 [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.
05/16/2013