Medicaid and State Children's Health Insurance Plan (SCHIP) Managed Care

Forms and Documents

Document Name	Status
Form CMS-10178 Medicaid and State Children's Health Insurance Plan (SCHIP) Managed Care Form and Instruction	Modified
OMB Clearance of CAP SHO Letter.txt Supplementary Document	2007-10-31
Justification of Non-material Change.doc Justification for No Material/Nonsubstantive Change	2007-10-31
CMS-10178 Supporting Statement.4-19-06.doc Supporting Statement A	2007-10-31

IC Document Collections

IC ID	Document Title	Status
43679	Medicaid and State Children's Health Insurance Plan (SCHIP) Managed Care Form and Instruction	Modified

ICR Details

OMB Control No: 0938-0994	ICR Reference No: 200711-0938-005
Status: Historical Active	Previous ICR Reference No: 200604-0938-003
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicaid and State Children's Health Insurance Plan (SCHIP) Managed Care
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/29/2008
	Date Received in OIRA: 11/19/2007
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2009	09/30/2009	09/30/2009
Responses	23,400	0	23,400
Time Burden (Hours)	23,400	0	23,400
Cost Burden (Dollars)	0	0	0

---

Abstract: The Improper Payments Information Act (IPIA) of 2002 requires CMS to produce national error rates in the Medicaid program and in SCHIP. To comply with the IPIA, CMS will engage a Federal contractor to produce error rates in Medicaid managed care and SCHIP managed care. Beginning in 2007, CMS will use a rotational approach to review up to 18 States for each program, for a total 36 States each year. CMS has completed the State selection process for the Medicaid improper payments measurement. States have not yet been selected for the measurement of improper payments...

---

Authorizing Statute(s): None

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Medicaid and State Children's Health Insurance Plan (SCHIP) Managed Care	CMS-10178	CAP SHO Letter

---

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	23,400	23,400	0	0	0	0
Annual Time Burden (Hours)	23,400	23,400	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 11/19/2007

---