Reinstatement of Prior Burden Estimates for CMS-10184E

Payment Error Rate Measurement - State Medicaid and CHIP Eligibility

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1012 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10184.FINAL-PE Reinstatement of Prior Burden Estimates for CMS-10184E Form
CMS-10184.PERM_Form_Instructions-10-30-06.DOC Instruction
CMS-10184.FINAL-PE CMS-10184.FINAL-PERM_Eligibility_Error_Rate_Forms CMS-10184.FINAL-PERM_Eligibility_Error_Rate_Forms-10-30-06.doc Form

Information Collection (IC) Details

IC Title:	Reinstatement of Prior Burden Estimates for CMS-10184E	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Form	CMS-10184.FINAL-PERM_Eligibility_Error_Rate_Forms	CMS-10184.FINAL-PERM_Eligibility_Error_Rate_Forms	CMS-10184.FINAL-PERM_Eligibility_Error_Rate_Forms-10-30-06.doc		Yes	Yes	Fillable Fileable
Instruction			CMS-10184.PERM_Form_Instructions-10-30-06.DOC		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 17	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	204	204
Annual IC Time Burden (Hours)	20,400	20,400
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.