Information Collection

Paryment Error Rate Measurement - State Medicaid and SCHIP Eligibility

IC 46148 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Paryment 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:

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 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	34	34
Annual IC Time Burden (Hours)	3,400	3,400
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.