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Medicaid Statistical Information System
Medicaid Statistical Information System
OMB: 0938-0345
IC ID: 7978
OMB.report
HHS/CMS
OMB 0938-0345
ICR 200207-0938-004
IC 7978
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0345 can be found here:
2024-09-20 - Revision of a currently approved collection
2022-06-10 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Medicaid Statistical Information System
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
Obligation to Respond:
Mandatory
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
CMS-R-0284
Yes
Yes
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
53
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
212
0
0
0
0
212
Annual IC Time Burden (Hours)
2,120
0
0
0
0
2,120
Annual IC Cost Burden (Dollars)
45,000
0
0
0
0
45,000
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.