Reinstatement of Prior Burden Estimates for CMS-10184E

Payment Error Rate Measurement - State Medicaid and CHIP Eligibility

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1012 can be found here:

Documents and Forms

Document Name Document Type
Form CMS 10184 Reinstatement of Prior Burden Estimates for CMS-10184E Form and Instruction
101814E CMS-10184 10184 PERM Eligibility Review Findings new.pdf Form and Instruction
CMS 10184 CMS-10184 PERM Review Summary and Instructions final.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Reinstatement of Prior Burden Estimates for CMS-10184E	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS 10184	CMS-10184	PERM Review Summary and Instructions final.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	101814E	CMS-10184	10184 PERM Eligibility Review Findings new.pdf		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 17	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	204	204
Annual IC Time Burden (Hours)	20,400	20,400
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.