This request is
approved with the language revision to the Privacy Act Notice
agreed to by HHS, and under the condition that HHS supply us with a
report on this pilot within 18 months. This report should include
the statistical validity of the results to an expanded program
effectiveness in finding third party liability, ability to match
spouse and claimant records and what can be concluded from the
pilot results.
Inventory as of this Action
Requested
Previously Approved
12/31/1986
12/31/1986
100,000
0
0
3,333
0
0
0
0
0
SOCIAL SECURITY BENEFITS. MEDICARE
PROGRAMS. THE INFORMATION COLLECT VIA THIS FORM WILL BE USED TO
IDENTIFY AGED CLAIMANTS FOR SOCIAL SECURITY BENEFITS OR MEDICARE
WHO ARE COVERED BY EMPLOYMENT RELATED GROUP HEALTH PLANS IN ORDER
TO DETERMINE WHETHER THESE HEALTH PLANS MAY BE LIABLE FOR CERTAIN
MEDICAL EXPENSES INSTEAD OF MEDICARE. THE AFFECTED PUBLIC WILL
CONSIST OF ALL SUCH AGED CLAIMANTS IN A SIX STATE AREA FOR A PERIOD
OF 6 MONTHS.
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.