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

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

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	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 %

table that charts list of burden
	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

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.