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Medicaid Emergency Psychiatric Services Demonstration Evaluation - states

IC 209880 under ICR 201312-0938-018 · OMB 0938-1225.

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Form and Instruction
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Medicaid Emergency Psychiatric Services Demonstration Evaluation - states
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10487 Key Informant Interview Protocols Attachment_B.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

12 0
   
State, Local, and Tribal Governments
 
   0 %

  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 108 0 108 0 0 0
Annual IC Time Burden (Hours) 588 0 588 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
MEPD IRB Section 9 Rationale MEPD IRB Section 9 Rationale.pdf 02/27/2014
MEPD Protocols Medical Record Review Consent MEPD Protocols Medical Record Review Consent.pdf 02/27/2014
MEPD RequestFormExemption MEPD RequestFormExemption.pdf 02/27/2014
NEIRB_exemption_granted_112213 NEIRB_exemption_granted_112213.pdf 02/27/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.