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Medicaid Statistical Information System (CMS-R-284)
Medicaid Statistical Information System (CMS-R-284)
OMB: 0938-0345
IC ID: 7980
OMB.report
HHS/CMS
OMB 0938-0345
ICR 200911-0938-001
IC 7980
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0345 can be found here:
2024-09-20 - Revision of a currently approved collection
2022-06-10 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
msisdd99v5e.doc
Other-Other
SMM2700.doc
Instruction
NPI-final rule.pdf
NPI Final Rule
IC Document
PUBLIC LAW 104-hipaa.doc
Public Law 104-HIPAA
IC Document
bbalaw.doc
BBA Law
IC Document
mmalaw.doc
MMA Law
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Medicaid Statistical Information System (CMS-R-284)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Other
msisdd99v5e.doc
Yes
Yes
Fillable Fileable
Instruction
SMM2700.doc
No
No
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
51
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 New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
204
0
-8
0
0
212
Annual IC Time Burden (Hours)
2,040
0
-504
0
0
2,544
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
NPI Final Rule
NPI-final rule.pdf
01/09/2007
Public Law 104-HIPAA
PUBLIC LAW 104-hipaa.doc
01/09/2007
BBA Law
bbalaw.doc
01/09/2007
MMA Law
mmalaw.doc
01/09/2007
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.