OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 201605-0938-009 · OMB 0938-0035 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form CMS-1957 Social Security Office (SSO) Report of State Buy-in Problems Form Removed Available
Form CMS-1957 SSO Report of State Buy-in Problems Form New Repair queued
Form CMS-1957 Social Security Office (SSO) Report of State Buy-in Problems Form Removed Available
CMS-1957 Supporting Statement (2015) Final.docx Supporting Statement A Uploaded 2016-05-11 Available
IC Document Collections
IC IDCollectionTypeStatusForm
7787 Social Security Office (SSO) Report of State Buy-in Problems Form Removed
221460 SSO Report of State Buy-in Problems Form New
191528 Social Security Office (SSO) Report of State Buy-in Problems Form Removed
ICR Details
0938-0035 201605-0938-009
Historical Active 201305-0938-008
HHS/CMS CMS-1957
Social Security Office (SSO) Report of State Buy-in Problems
Extension without change of a currently approved collection   No
Regular
Approved with change 06/16/2016
Retrieve Notice of Action (NOA) 05/12/2016
  Inventory as of this Action Requested Previously Approved
06/30/2019 36 Months From Approved 09/30/2016
3,936 0 5,600
1,312 0 1,816
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
  81 FR 7124 02/10/2016
81 FR 22272 04/15/2016
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 3,936 5,600 0 3,936 -5,600 0
Annual Time Burden (Hours) 1,312 1,816 0 1,312 -1,816 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
The number of respondents increased since the last time this information collection was submitted for OMB approval. We have adjusted the burden accordingly. It is assumed that increase in forms received represents a beneficiary making more complaints than usual. The previous submission for approval of 5600 responses and 1816 time in burden hours is incorrect. It was supposed to be 3802 responses and 1267 time in burden hours. With this submission there was an increase from 3802 to 3936 responses due to complaints and an increase in burden hours from 1267 to 1312.
$27,355
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.
05/12/2016