Information Collection Request

Medicaid Emergency Psychiatric Demonstration

ICR 201106-0938-015 · OMB 0938-1131 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10382 Application Process Form and Instruction Modified Available
CMS-10382.(0938-1131).REVISED Solicitation (7-26-11).docx Supplementary Document Uploaded 2011-07-26 Available
CMS-10382.Justification of Nonmaterial Change.docx Justification for No Material/Nonsubstantive Change Uploaded 2011-06-16 Available
CMS-10382.Supporting Statement Part A.pdf Supporting Statement A Uploaded 2011-06-16 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
197223 Application Process Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
11/30/2011 11/30/2011 11/30/2011
54 0 54
2,160 0 2,160
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Application Process CMS-10382 CMS-10382-APPENDIX-1-Guidelines

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 54 54 0 0 0 0
Annual Time Burden (Hours) 2,160 2,160 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No