#8: (PIE) Payer Initiated Eligibility/Benefit Transaction

Generic Clearance for Medicaid and CHIP State Plan, Waiver, and Program Submissions (CMS-10398)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1148 can be found here:

Documents and Forms

Document Name Document Type
PIE - Attachment A PIE Transaction Companion Guide- June 2010 (2).pdf Instruction
PIE - Attachment B Companion Guide - Business Scenarios (2).pdf Instruction
PIE - Attachment C SMD10011 (2).pdf Instruction
#8 PIE Supporting Statement [Dec 2014].docx #8 Supporting Statement: (PIE) Payer Initiated Eligibility/Benefit Transaction IC Document

Information Collection (IC) Details

IC Title:	#8: (PIE) Payer Initiated Eligibility/Benefit Transaction	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Electronic Capability
Instruction	PIE - Attachment A PIE Transaction Companion Guide- June 2010 (2).pdf	No	Paper Only
Instruction	PIE - Attachment B Companion Guide - Business Scenarios (2).pdf	No	Paper Only
Instruction	PIE - Attachment C SMD10011 (2).pdf	No	Printable Only

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 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	56	56
Annual IC Time Burden (Hours)	1,120	1,120
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
#8 Supporting Statement: (PIE) Payer Initiated Eligibility/Benefit Transaction	#8 PIE Supporting Statement [Dec 2014].docx	12/22/2014

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.