Information Collection

State Plan Preprint for Medicaid Recovery Audit Contractor (RAC) Program (CMS-10343)

IC 197006 under ICR 201103-0938-008 · OMB 0938-1126.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1126 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CMS-10343 Medicaid RACs DRAFT preprint7-29-10 [Jan 14_2011].doc	Other-CMS-0343 - - State Plan Prepri

IC Title:

State Plan Preprint for Medicaid Recovery Audit Contractor (RAC) Program (CMS-10343)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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
Other-CMS-0343 - - State Plan Preprint for Medicaid Recovery Audit Contractor (RAC) Program			CMS-10343 Medicaid RACs DRAFT preprint7-29-10 [Jan 14_2011].doc		Yes	Yes	Fillable Printable

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	Program Change Due to New Statute
Annual Number of Responses for this IC	56	56
Annual IC Time Burden (Hours)	56	56
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.