Information Collection

#28: MMIS APD Template NCCI Coding Initiative (CMS-10358)

IC 214338 under ICR 201410-0938-016 · OMB 0938-1148.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10398 (#28) #28: MMIS APD Template NCCI Coding Initiative (CMS-10358)	Form and Instruction
CMS-10398 (#28) Advance Planning Document (APD) Template for Implementat MedicaidNCCIAPDFinal 508 version [rev 1-30-2014 by OSORA PRA].pdf	Form and Instruction
#28 MMISAPDTemplateNCCICodingSupportingStatement [Dec 2014].docx #28 Supporting Statement: MMIS APD Template NCCI Coding Initiative	IC Document

IC Title:

#28: MMIS APD Template NCCI Coding Initiative (CMS-10358)

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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 and Instruction	CMS-10398 (#28)	Advance Planning Document (APD) Template for Implementation of the National Correct Coding Initiative (NCCI) in a Stateâs Medicaid Management Information System (MMIS)	MedicaidNCCIAPDFinal 508 version [rev 1-30-2014 by OSORA PRA].pdf		Yes	Yes	Fillable Printable

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
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	280	280
Annual IC Time Burden (Hours)	840	840
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
#28 Supporting Statement: MMIS APD Template NCCI Coding Initiative	#28 MMISAPDTemplateNCCICodingSupportingStatement [Dec 2014].docx	12/23/2014

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