Information Collection

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

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

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.