Information Collection

State Medicaid HIT Plan and Templates for Implementation of Section 4201 of ARRA (CMS-10292)

IC 192702 under ICR 201004-0938-008 · OMB 0938-1088.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1088 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
STATE MEDICAID HIT PLAN.pdf	Other-State Medicaid Hit Plan
CMS-10292 Model Checklist: HIT P-APD Model HIT P-APD.pdf	Form

IC Title:

State Medicaid HIT Plan and Templates for Implementation of Section 4201 of ARRA (CMS-10292)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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-State Medicaid Hit Plan			STATE MEDICAID HIT PLAN.pdf		Yes	Yes	Fillable Fileable
Form	CMS-10292	Model Checklist: HIT P-APD	Model HIT P-APD.pdf		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 New Statute
Annual Number of Responses for this IC	56	56
Annual IC Time Burden (Hours)	56	56
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.