Information Collection

State Plan Preprint for Medicaid Recovery Audit Contractor (RAC) Program (CMS-10343)

IC 197006 under ICR 201410-0938-007 · OMB 0938-1126.

Documents and Forms

Document Name Document Type
Form CMS-10343 State Plan Preprint for Medicaid Recovery Audit Contractor (RAC) Program (CMS-10343) Form
CMS-10343 State Plan Preprint for Medicaid Recover Audit Contracto CMS-10343_Instrument.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State Plan Preprint for Medicaid Recovery Audit Contractor (RAC) Program (CMS-10343)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10343	State Plan Preprint for Medicaid Recover Audit Contractor (RAC) Program	CMS-10343_Instrument.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 56	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	56	56
Annual IC Time Burden (Hours)	56	56
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.