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Evaluation Requirements (431.424(d))
Medicaid Program; Review and Approval Process for Section 1115 Demonstrations (CMS-10341)
OMB: 0938-1162
IC ID: 196281
OMB.report
HHS/CMS
OMB 0938-1162
ICR 201503-0938-001
IC 196281
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1162 can be found here:
2021-11-30 - Extension without change of a currently approved collection
2018-06-12 - Reinstatement without change of a previously approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Evaluation Requirements (431.424(d))
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
Obligation to Respond:
Mandatory
CFR Citation:
42 CFR 431.424(d)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
10
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
10
0
0
0
0
10
Annual IC Time Burden (Hours)
1,600
0
0
0
0
1,600
Annual IC Cost Burden (Dollars)
0
0
0
0
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.