Information Collection

Medicaid State Program Integrity Assessment (SPIA) CMS-10244

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

Documents and Forms

Document Name Document Type
Form CMS-10244 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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Medicaid State Program Integrity Assessment (SPIA) CMS-10244	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10244	Medicaid State Program Integrity Assessment (SPIA)	Appendix B - SPIADataCollectionInstrument.pdf		Yes	No	Fillable Fileable
Other-Glossary (terms in the form & instruction)			Appendix C - SPIA Glossary.pdf		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 %

	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

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.