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GenIC #26 (Extension w/o change): Medicaid Adult Core Set Measures Reporting Template

IC 229683 under ICR 201712-0938-019 · OMB 0938-1148.

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Form and Instruction
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GenIC #26 (Extension w/o change): Medicaid Adult Core Set Measures Reporting Template
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10398 #26 Medicaid Adult Core Set Measures Template 26 - GenIC _26 FFY 2014 Medicaid Adult Quality Measures Template (clean).docx Yes Yes Fillable Fileable

Health Health Care Services

 

56 0
   
State, Local, and Tribal Governments
 
   100 %

  Requested 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 56 0 56 0 0 0
Annual IC Time Burden (Hours) 2,240 0 2,240 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
#26 - Supporting Statement 26 - Revised Supporting Statement Medicaid Adult Core Set Measures.docx 01/08/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.