Information Collection

Medicaid State Program Integrity Assessment (SPIA) CMS-10244

IC 182825 under ICR 201012-0938-014 · OMB 0938-1033.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10244 Medicaid State Program Integrity Assessment (SPIA) Medicaid State Program Integrity Assessment (SPIA) CMS-10244	Form and Instruction
Appendix C - SPIA Glossary.pdf	Other-Glossary (terms in the form &
CMS-10244 Medicaid State Program Integrity Assessment (SPIA) Appendix B - SPIADataCollectionInstrument.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Form and Instruction	CMS-10244				Yes	No	Fillable Fileable
Other-Glossary (terms in the form & instruction)					Yes	No	Printable Only

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	Previously Approved
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
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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