Information Collection

(Private Sector) External Quality Review of Medicaid MCOs and Supporting Regulations in 42 CFR 438.360, 438.362, and 438.364

IC 216824 under ICR 201611-0938-016 · OMB 0938-0786.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0786 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
01. Introduction To Protocols [11-2016].pdf	Instruction
02. P1Compliance_Review.pdf	Instruction
03. P1AttachA_ComplianceReviewWrk.pdf	Instruction
04. P1AttachB_ComplianceDefinitions.pdf	Instruction
05. P1AttachC_SampleSiteVisitAgenda.pdf	Instruction
06. P1AttachD_Compliance_Inter.pdf	Instruction
07. P2Validation_of_Measures.pdf	Instruction
08. P2AttachA-PM Validation Wksht.pdf	Instruction
09. P3PIP_Validation.pdf	Instruction
10. P3AttachA-PIPwrksht.pdf	Instruction
11. P4Validate_EnounterData.pdf	Instruction
12. P4AttachA-EncounterDataTables.pdf	Instruction
13. P4AttachB-MedicalRecordReview_wksht.pdf	Instruction
14. P5Surveys.pdf	Instruction
15. P5AttachA_SurveyValidationWksht.pdf	Instruction
16. P6PMValidation.pdf	Instruction
17. P6AttachA-PMCalculationTables.pdf	Instruction
18. P7PIP_Implementation.pdf	Instruction
19. P8FocusedStudies.pdf	Instruction
20. App1_Methodology.pdf	Instruction
21. App2_SamplingApproaches.pdf	Instruction
22. App3_Glossary.pdf	Instruction
24. App5_ISAssessment.pdf	Instruction
25. App5_AttachA-ISCA.pdf	Instruction
26. App5_AttachB-ISReview.pdf	Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

(Private Sector) External Quality Review of Medicaid MCOs and Supporting Regulations in 42 CFR 438.360, 438.362, and 438.364

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction	01. Introduction To Protocols [11-2016].pdf	Yes	Yes	Fillable Printable
Instruction	02. P1Compliance_Review.pdf	Yes	Yes	Fillable Printable
Instruction	03. P1AttachA_ComplianceReviewWrk.pdf	Yes	Yes	Fillable Printable
Instruction	04. P1AttachB_ComplianceDefinitions.pdf	Yes	Yes	Fillable Printable
Instruction	05. P1AttachC_SampleSiteVisitAgenda.pdf	Yes	Yes	Fillable Printable
Instruction	06. P1AttachD_Compliance_Inter.pdf	Yes	Yes	Fillable Printable
Instruction	07. P2Validation_of_Measures.pdf	Yes	Yes	Fillable Printable
Instruction	08. P2AttachA-PM Validation Wksht.pdf	Yes	Yes	Fillable Printable
Instruction	09. P3PIP_Validation.pdf	Yes	Yes	Fillable Printable
Instruction	10. P3AttachA-PIPwrksht.pdf	Yes	Yes	Fillable Printable
Instruction	11. P4Validate_EnounterData.pdf	Yes	Yes	Fillable Printable
Instruction	12. P4AttachA-EncounterDataTables.pdf	Yes	Yes	Fillable Printable
Instruction	13. P4AttachB-MedicalRecordReview_wksht.pdf	Yes	Yes	Fillable Printable
Instruction	14. P5Surveys.pdf	Yes	Yes	Fillable Printable
Instruction	15. P5AttachA_SurveyValidationWksht.pdf	Yes	Yes	Fillable Printable
Instruction	16. P6PMValidation.pdf	Yes	Yes	Fillable Printable
Instruction	17. P6AttachA-PMCalculationTables.pdf	Yes	Yes	Fillable Printable
Instruction	18. P7PIP_Implementation.pdf	Yes	Yes	Fillable Printable
Instruction	19. P8FocusedStudies.pdf	Yes	Yes	Fillable Printable
Instruction	20. App1_Methodology.pdf	Yes	Yes	Fillable Printable
Instruction	21. App2_SamplingApproaches.pdf	Yes	Yes	Fillable Printable
Instruction	22. App3_Glossary.pdf	Yes	Yes	Fillable Printable
Instruction	24. App5_ISAssessment.pdf	Yes	Yes	Fillable Printable
Instruction	25. App5_AttachA-ISCA.pdf	Yes	Yes	Fillable Printable
Instruction	26. App5_AttachB-ISReview.pdf	Yes	Yes	Fillable Printable

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: 561

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	578	578
Annual IC Time Burden (Hours)	103,626	103,626
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.