Information Collection

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

IC 192702 under ICR 201108-0938-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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) State Medicaid HIT Plan (SMHP) and Template for Implementation of Section 4201 of ARRA (CMS-10292)	Form and Instruction
Form CMS-10292 (HIT P-A Model Checklist: HIT Planning-Advance Planning Document (HIT P-APD) State Medicaid HIT Plan (SMHP) and Template for Implementation of Section 4201 of ARRA (CMS-10292)	Form and Instruction
Form CMS-10292 (IAPD) Implementation Advanced Planning Document (IAPD) Template 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
CMS-10292 (IAPD) Implementation Advanced Planning Document (IAPD) Templat Medicaid_HIT_IAPD_Template_06_20_2011.docx	Form and Instruction

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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10292 (SMHP)	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10292 (HIT P-APD)	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10292 (IAPD)	Yes	Yes	Printable 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: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	56	0	56
Annual IC Time Burden (Hours)	896	616	280
Annual IC Cost Burden (Dollars)	0	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.

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