Information Collection

State Medicaid HIT Plan (SMHP) and Template for Implementation of Section 4201 of ARRA (CMS-10292)

IC 192702 under ICR 201712-0938-009 · OMB 0938-1088.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1088 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CMS-10292 HIT PAPD Template1 20170509.pdf	Instruction
CMS-10292 State Medicaid HIT Plan Template1 20170509.pdf	Instruction
CMS-10292 Health Information Technology (HIT) Implementation Advan CMS-10292 HIT IAPD Template1 20170509.pdf	Form and Instruction

IC Title:

State Medicaid HIT Plan (SMHP) and Template for Implementation of Section 4201 of ARRA (CMS-10292)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			CMS-10292 HIT PAPD Template1 20170509.pdf	Yes	Yes	Fillable Printable
Instruction			CMS-10292 State Medicaid HIT Plan Template1 20170509.pdf	Yes	Yes	Fillable Printable
Form and Instruction	CMS-10292	Health Information Technology (HIT) Implementation Advanced Planning Document (IAPD)	CMS-10292 HIT IAPD Template1 20170509.pdf	Yes	Yes	Fillable Printable

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	Previously Approved
Annual Number of Responses for this IC	56	56
Annual IC Time Burden (Hours)	896	896
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.