Medicaid Statistical Information System

Medicaid Statistical Information System

OMB: 0938-0345

IC ID: 7980

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)

Medicaid Statistical Information System
 
No Migrated
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-R-284 Yes Yes


    

53 0
   
State, Local, and Tribal Governments
 
   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 -5,300 0 7,420
Annual IC Cost Burden (Dollars) 64,000 0 0 -121,000 0 185,000

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

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