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Payment Error Rate Measurement in Medicaid and the State Children Health Insurance Program
Payment Error Rate Measurement in Medicaid and the State Children Health Insurance Program
OMB: 0938-0974
IC ID: 8834
OMB.report
HHS/CMS
OMB 0938-0974
ICR 201309-0938-009
IC 8834
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0974 can be found here:
2024-05-28 - Reinstatement with change of a previously approved collection
2016-09-29 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
Form CMS-10166
Payment Error Rate Measurement in Medicaid and the State Children Health Insurance Program
Form and Instruction
CMS-10166 CAP SHO Letter
CAP SHO Letter FINAL to OMB 090407.doc
Form and Instruction
CMS-10166 IPIA
IPIA.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Payment Error Rate Measurement in Medicaid and the State Children Health Insurance Program
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
42 CFR 431.970
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
CMS-10166
CAP SHO Letter
CAP SHO Letter FINAL to OMB 090407.doc
No
No
Fillable Fileable
Form
CMS-10166
IPIA
IPIA.pdf
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
34
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
99 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
34
0
0
0
34
0
Annual IC Time Burden (Hours)
56,100
0
0
27,540
28,560
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.