Information Collection

MMIS APD Template for Use by States When Implementing the Mandatory National Correct Coding Initiative in Medicaid

IC 196408 under ICR 201102-0938-013 · OMB 0938-1123.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Medicaid NCCI APD Template Draft [rev 03-25-11].docx	Other-APD Template for State Impleme

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 19 CFR 1903

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-APD Template for State Implementation of the NCCI in Medicaid			Medicaid NCCI APD Template Draft [rev 03-25-11].docx		No		Paper 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: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	56	56
Annual IC Time Burden (Hours)	168	168
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.