This collection
is approved based on the revised materials provided by the
Agency.
Inventory as of this Action
Requested
Previously Approved
08/31/2018
36 Months From Approved
10/31/2015
51,581
0
67,034
4,299
0
5,586
0
0
0
Medicaid state agencies must identify
third party insurers liable for medical care or services for
Medicaid beneficiaries; this reduces Medicaid costs. Regulations at
42 CFR 433.136433.139 require Medicaid state agencies to obtain
this information on Medicaid applications and redeterminations as a
condition of Medicaid eligibility. States may enter into agreements
with the Commissioner of Social Security to make Medicaid
eligibility determinations for aged, blind, and disabled
beneficiaries in those states. Applications for and
redeterminations of Supplemental Security Income (SSI) eligibility
in jurisdictions with such agreements are applications and
redeterminations of Medicaid eligibility. Under these agreements,
SSA obtains third party liability information using Form SSA- 8019
and provides that information to the Medicaid state agencies. The
Medicaid state agencies use the information to bill third parties
liable for medical care, support, or services for a beneficiary to
guarantee that Medicaid remains the payer of last resort. The
respondents are SSI claimants and recipients.
US Code:
42
USC 1396a Name of Law: Social Security Act
US Code: 42
USC 1383c Name of Law: Social Security Act
There has been a decrease in
the burden hours. The change in hours reflects normal workload
variations, and a decrease in the number of users. Based on the
nature and purpose of the form there have been fewer situations
where the form has been necessary.
$531,694
No
No
No
No
No
Uncollected
Faye Lipsky 410 965-8783
faye.lipsky@ssa.gov
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.