Information Collection

Certification of Medicaid Eligibilty Quality Control (MEQC) Payment Error Rates and Supporting Regulations at 42 CFR.431.800 through 431.865

IC 7904 under ICR 201308-0938-025 · OMB 0938-0246.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-301 CMS-301.MEQC Annual Report Certification of Medicaid Eligibilty Quality Control (MEQC) Payment Error Rates and Supporting Regulations at 42 CFR.431.800 through 431.865	Form and Instruction
Form CMS-301 Certfication of Eligibility/Error Rate Certification of Medicaid Eligibilty Quality Control (MEQC) Payment Error Rates and Supporting Regulations at 42 CFR.431.800 through 431.865	Form
CMS-301 CMS-301.MEQC Annual Report CMS-301.MEQC Annual Report.DOC	Form and Instruction
CMS-301 Certfication of Eligibility/Error Rate CMS-301 (2).pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 431.800-865

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
Form and Instruction	CMS-301				Yes	No	Fillable Fileable
Form	CMS-301				Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 51

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	51	51
Annual IC Time Burden (Hours)	16,446	16,446
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.

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