Information Collection

Medicaid State Program Integrity Assessment (SPIA) CMS-10244

IC 182825 under ICR 200711-0938-013 · OMB 0938-1033.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1033 can be found here:

Documents and Forms

Document Name Document Type
Appendix B - Draft SPIA Data Collection Instrument 10-11-07.doc Other-Information Management System
Appendix C - DRAFT Medicaid Integrity Glossary 10-10-07.doc Appendix C - DRAFT Medicaid Integrity Glossary 10-10-07 IC Document
Appendix A - SPIA Case Study Pilot Summary.doc Appendix A - SPIA Case Study Pilot Summary IC Document
Appendix D - DRA of 2005 Section 6034.pdf Appendix D - DRA of 2005 Section 6034 IC Document
Appendix E - 42 CFR 455.pdf Appendix E - 42 CFR 455 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Medicaid State Program Integrity Assessment (SPIA) CMS-10244	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 455

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Information Management System			Appendix B - Draft SPIA Data Collection Instrument 10-11-07.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 56	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 Agency Discretion
Annual Number of Responses for this IC	56	56
Annual IC Time Burden (Hours)	1,400	1,400
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Appendix C - DRAFT Medicaid Integrity Glossary 10-10-07	Appendix C - DRAFT Medicaid Integrity Glossary 10-10-07.doc	10/31/2007
Appendix A - SPIA Case Study Pilot Summary	Appendix A - SPIA Case Study Pilot Summary.doc	10/31/2007
Appendix D - DRA of 2005 Section 6034	Appendix D - DRA of 2005 Section 6034.pdf	10/31/2007
Appendix E - 42 CFR 455	Appendix E - 42 CFR 455.pdf	10/31/2007

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