Treatment of Pediatric ADHD: An Assessment of State Medicaid Policies

Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Document Name Document Type
Treatment of Pediatric ADHD: An Assessment of State Medicaid Policies Form
Prior Authorization Policies for Pediatric ADHD Medicati Attachment B- Instrument_PDF Version.pdf Form
Attachment A- Instrument_Word Version.docx Word Version of the Information Collection Instrument (for reference) IC Document
Attachment C- Notification Email.docx Notification Email IC Document
Attachment D- Launch Email.docx Launch Email IC Document
Attachment E- Reminder Email.docx Reminder Email IC Document
ADHD-PA-SSA.docx Supporting Statement Part A IC Document
ADHD-PA-SSB.docx Supporting Statement Part B IC Document

Information Collection (IC) Details

IC Title:	Treatment of Pediatric ADHD: An Assessment of State Medicaid Policies	Agency IC Tracking Number:	0920-17BD

IC Status: New

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	N/A	Prior Authorization Policies for Pediatric ADHD Medication Prescriptions	Attachment B- Instrument_PDF Version.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 51	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	51	51
Annual IC Time Burden (Hours)	17	17
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Word Version of the Information Collection Instrument (for reference)	Attachment A- Instrument_Word Version.docx	11/10/2016
Notification Email	Attachment C- Notification Email.docx	11/10/2016
Launch Email	Attachment D- Launch Email.docx	11/10/2016
Reminder Email	Attachment E- Reminder Email.docx	11/10/2016
Supporting Statement Part A	ADHD-PA-SSA.docx	11/10/2016
Supporting Statement Part B	ADHD-PA-SSB.docx	11/10/2016

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