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

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

Information Collection (IC) Details

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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

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.