Summary of Eligibility and Payment Review Findings

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

OMB: 0938-1012

IC ID: 46148

Information Collection (IC) Details

View Information Collection (IC)

Summary of Eligibility and Payment Review Findings
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 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
 
   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 34 0 0 0 0 34
Annual IC Time Burden (Hours) 3,400 0 0 0 0 3,400
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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