CHIP and Medicaid Personnel

CHIPRA_ Children Health Insurance

Documents and Forms

Document Name Document Type
CHIP Part A_Attachment C1_Case Studies_State Officials.pdf Other-discussion guide
0990-CHIP Part B_Attachment C2_Case Studies_Community Enrollment Agencies.pdf Other-discussion guide
0990-CHIP Part B_Attachment C3_Case Studies_Health Care Providers.pdf Other-discussion guide
0990-CHIP Part B_Attachment C4_Case Studies_Managed Care and Health Plans.pdf Other-discussion guide

Information Collection (IC) Details

IC Title:	CHIP and Medicaid Personnel	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-discussion guide	CHIP Part A_Attachment C1_Case Studies_State Officials.pdf	Yes	Yes	Fillable Fileable
Other-discussion guide	0990-CHIP Part B_Attachment C2_Case Studies_Community Enrollment Agencies.pdf	Yes	Yes	Fillable Fileable
Other-discussion guide	0990-CHIP Part B_Attachment C3_Case Studies_Health Care Providers.pdf	Yes	Yes	Fillable Fileable
Other-discussion guide	0990-CHIP Part B_Attachment C4_Case Studies_Managed Care and Health Plans.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	300	300
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.