Information Collection

GenIC #28 (Extension w/o change): MMIS APD Template NCCI Coding Initiative

IC 229687 under ICR 201712-0938-019 · OMB 0938-1148.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1148 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10398 #28 GenIC #28 (Extension w/o change): MMIS APD Template NCCI Coding Initiative	Form and Instruction
CMS-10398 #28 Advance Planning Document (APD) Template for Implementat 28 - MedicaidNCCIAPD Final.pdf	Form and Instruction
28 - Supporting Statement MMIS APD Template NCCI Coding Initiative.docx #28 - Supporting Statement	IC Document

IC Title:

GenIC #28 (Extension w/o change): MMIS APD Template NCCI Coding Initiative

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Mandatory

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 and Instruction	CMS-10398 #28	Advance Planning Document (APD) Template for Implementation of the National Correct Coding Initiative (NCCI) in a Stateâs Medicaid Management Information System (MMIS)	28 - MedicaidNCCIAPD Final.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
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	280	280
Annual IC Time Burden (Hours)	840	840
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
#28 - Supporting Statement	28 - Supporting Statement MMIS APD Template NCCI Coding Initiative.docx	01/09/2018

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.