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

MMIS APD Template for Use by States When Implementing the Mandatory National Correct Coding Initiative in Medicaid, implementation of Section 6507 of ACA (CMS-10358)

Documents and Forms

Document Name Document Type
Medicaid NCCI APD Template Draft [rev 03-25-11].docx Other-APD Template for State Impleme

Information Collection (IC) Details

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

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 %

	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

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.