Information Collection

CHIP and Medicaid Personnel

IC 199535 under ICR 201110-0990-006 · OMB 0990-0384.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

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	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 %

table that charts list of burden
	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

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.