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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.