Information Collection

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

IC 113722 under ICR 198605-0938-016 · OMB 0938-0438.

⚠️ Notice: This information collection may be referencing outdated material.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

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Information Collection (IC) Details

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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

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