Sampling Plan

Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (CMS-10184)

OMB: 0938-1012

IC ID: 46143

Information Collection (IC) Details

View Information Collection (IC)

Sampling Plan
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction -CMS-10184.Instructions for Completing the PERM Monthly Sample Selection List.doc Yes No Printable Only
Form CMS-10184 Monthly Sample Selection List -CMS-10184.Monthly Sample Selection List.doc Yes Yes Fillable Fileable

Health Health Care Services

 

34 0
   
State, Local, and Tribal Governments
 
   10 %

  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 34 0 0 0 0 34
Annual IC Time Burden (Hours) 34,000 0 0 0 0 34,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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