(medicaid) Clearance Of Information Collection Requirements In Part Ii, Chapter Vi Of The State Medicaid Manual On The Claims Processing Assessment System (cpas)

(MEDICAID) CLEARANCE OF INFORMATION COLLECTION REQUIREMENTS IN PART II, CHAPTER VI OF THE STATE MEDICAID MANUAL ON THE CLAIMS PROCESSING ASSESSMENT SYSTEM (CPAS)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0438 can be found here:

Documents and Forms

Document Name Document Type

no available documents/forms check other ICs listed under this ICR

Information Collection (IC) Details

IC Title:	(MEDICAID) CLEARANCE OF INFORMATION COLLECTION REQUIREMENTS IN PART II, CHAPTER VI OF THE STATE MEDICAID MANUAL ON THE CLAIMS PROCESSING ASSESSMENT SYSTEM (CPAS)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	HCFA-R-91	No	No
Form	HCFA-331	No	No
Form	HCFA-503	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 55	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	55	0	55
Annual IC Time Burden (Hours)	66,491	64,417	2,074
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.