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

Medicaid and CHIP Program (MACPro) (CMS-10434)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1188 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10434 #45 GenIC # 45 (Transfer from 0938-1148): Maternal and Infant Health Quality Form
CMS-10434 #45 MIHQM2017-AdminScreen QSSI-MACPro-PRA-MIHQM2017-AdminScreen.pdf Form
CMS-10434 #45 MIHQM2017-CCW QSSI-MACPro-PRA-MIHQM2017-CCW.pdf Form
45 - Generic Supporting Statement (2019 Version 1).docx Generic Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	GenIC # 45 (Transfer from 0938-1148): Maternal and Infant Health Quality	Agency IC Tracking Number:	CMCS

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 56	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	112	112
Annual IC Time Burden (Hours)	112	112
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.