OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

GenIC # 45 (Transfer from 0938-1148): Maternal and Infant Health Quality

IC 236830 under ICR 201708-0938-004 · OMB 0938-1188.

Documents and Forms
Document Name
Document Type
Form
Form
Form
IC Document
Information Collection (IC) Details

View Information Collection (IC)

GenIC # 45 (Transfer from 0938-1148): Maternal and Infant Health Quality CMCS
 
New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10434 #45 MIHQM2017-AdminScreen QSSI-MACPro-PRA-MIHQM2017-AdminScreen.pdf Yes Yes Fillable Fileable
Form CMS-10434 #45 MIHQM2017-CCW QSSI-MACPro-PRA-MIHQM2017-CCW.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

56 0
   
State, Local, and Tribal Governments
 
   100 %

  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 112 0 112 0 0 0
Annual IC Time Burden (Hours) 112 0 112 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Generic Supporting Statement 45 - Generic Supporting Statement (2019 Version 1).docx 07/15/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.