Information Collection

Payment Error Rate Measurement - State Medicaid and SCHIP Eligibility

IC 46147 under ICR 200611-0938-008 · OMB 0938-1012.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1012 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10184 CMS-10184 Payment Error Rate Measurement - State Medicaid and SCHIP Eligibility	Form
Form CMS-10184 CMS-10184.FINAL-PERM Eligibility Error Rate Forms Payment Error Rate Measurement - State Medicaid and SCHIP Eligibility	Form
CMS-10184 REVISED - PERM Form Instructions-1-24-07.DOC	Instruction
CMS-10184.PERM Form Instructions-10-30-06.DOC	Instruction
CMS-10184 CMS-10184 CMS-10184 REVISED Error Rate Forms-1-24-07.doc	Form
CMS-10184 CMS-10184.FINAL-PERM Eligibility Error Rate Forms CMS-10184.FINAL-PERM Eligibility Error Rate Forms-10-30-06.doc	Form

IC Title:

Payment Error Rate Measurement - State Medicaid and SCHIP Eligibility

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			CMS-10184.PERM Form Instructions-10-30-06.DOC	Yes	No	Printable Only
Form	CMS-10184	CMS-10184.FINAL-PERM Eligibility Error Rate Forms	CMS-10184.FINAL-PERM Eligibility Error Rate Forms-10-30-06.doc	Yes	No	Fillable Printable
Form	CMS-10184	CMS-10184	CMS-10184 REVISED Error Rate Forms-1-24-07.doc	Yes	No	Fillable Printable
Instruction			CMS-10184 REVISED - PERM Form Instructions-1-24-07.DOC	Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 34

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	408	408
Annual IC Time Burden (Hours)	40,800	40,800
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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