State Medicaid Fraud Control Units Annual Report and Recertification Application

Forms and Documents

Document Name	Status
0990-0162 MFCU Documentation Part Two doc.doc Supporting Statement A	2010-10-29

IC Document Collections

IC ID	Document Title	Status
181665	Certification/Recertification Application	Modified
10317	State Medicaid Fraud Control Units Annual Report and Recertification Application	Modified

ICR Details

OMB Control No: 0990-0162	ICR Reference No: 201010-0990-003
Status: Historical Active	Previous ICR Reference No: 200708-0990-001
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: State Medicaid Fraud Control Units Annual Report and Recertification Application
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/06/2011
	Date Received in OIRA: 10/29/2010
Terms of Clearance: Approved consistent with the understanding that the information collection requirements are prescribed in regulation and no forms are used to collect the information.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2014	36 Months From Approved	01/31/2011
Responses	100	0	98
Time Burden (Hours)	4,650	0	4,557
Cost Burden (Dollars)	0	0	0

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Abstract: The information contained in the annual reports and recertification application requests is required for the yearly certification/recertification of the current 49 state Medicaid Fraud Control Units by the Office of Inspector General (OIG). The information collected is reviewed and evaluated by the OIG to insure that federal matching grant funds to the Units are only expended for allowable costs incurred by the Units. The OIG also uses the information to determine if a particular state unit or units' needs technical assistance.

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Authorizing Statute(s): PL: Pub.L. 95 - 142 17 Name of Law: null
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 52947	08/30/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 66101	10/27/2010
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
State Medicaid Fraud Control Units Annual Report and Recertification Application
Certification/Recertification Application

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ICR Summary of Burden

	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	100	98	0	0	2	0
Annual Time Burden (Hours)	4,650	4,557	0	0	93	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $5,400

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 10/29/2010

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