Information Collection

State Medicaid HIT Plan (SMHP) and Template for Implementation of Section 4201 of ARRA (CMS-10292)

IC 192702 under ICR 201103-0938-002 · OMB 0938-1088.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1088 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10292 (SMHP) State Medicaid HIT Plan (SMHP) and Template for Implementation of Section 4201 of ARRA (CMS-10292)	Form and Instruction
CMS-10292 (SMHP) State Medicaid HIT Plan (SMHP) STATE_MEDICAID_HIT_PLAN_Update_09152010 Rev.doc	Form and Instruction
CMS-10292 (HIT P-A Model Checklist: HIT Planning-Advance Planning Document Model HIT P-APD Update 9 15 10 Rev.doc	Form and Instruction
Crosswalk for changes to SMHP_02142011.docx Crosswalk - SMHP	IC Document

IC Title:

State Medicaid HIT Plan (SMHP) and Template for Implementation of Section 4201 of ARRA (CMS-10292)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

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-10292 (SMHP)	State Medicaid HIT Plan (SMHP)	STATE_MEDICAID_HIT_PLAN_Update_09152010 Rev.doc		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10292 (HIT P-APD)	Model Checklist: HIT Planning-Advance Planning Document (HIT P-APD)	Model HIT P-APD Update 9 15 10 Rev.doc		Yes	Yes	Fillable Fileable

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	56	0	56
Annual IC Time Burden (Hours)	280	224	56
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Crosswalk - SMHP	Crosswalk for changes to SMHP_02142011.docx	02/19/2011

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