Information Collection

Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (MEQC Substitution)

IC 190303 under ICR 201002-0938-008 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10184D Detailed Payment Review Findings Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (MEQC Substitution)	Form and Instruction
Form CMS-10184A Cases Selected for Review: Monthly Sample Selection List Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (MEQC Substitution)	Form and Instruction
Form CMS-10184B Detailed Active Case Review Findings Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (MEQC Substitution)	Form and Instruction
Form CMS-10184E Summary Findings Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (MEQC Substitution)	Form and Instruction
CMS-10184D Detailed Payment Review Findings CMS 10184D MEQC substitution 7-8-09.doc	Form and Instruction
CMS-10184A Cases Selected for Review: Monthly Sample Selection List CMS 10184A MEQC substitution 7-8-09.doc	Form and Instruction
CMS-10184B Detailed Active Case Review Findings CMS 10184B MEQC substitution 7-8-09.doc	Form and Instruction
CMS-10184E Summary Findings CMS 10184E MEQC substitution 7-8-09.doc	Form and Instruction

IC Title:

Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (MEQC Substitution)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10184D	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10184A	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10184B	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10184E	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 19

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	19	19
Annual IC Time Burden (Hours)	407,094	407,094
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

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