Information Collection

GenIC #45 (Extension w/o change): Maternal and Infant Health Quality

IC 229715 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⚠️ Notice: This information collection may be referencing outdated material.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 #45 GenIC #45 (Extension w/o change): Maternal and Infant Health Quality	Form
CMS-10398 #45 Maternal and Infant Health (MIH) Quality Screenshot #1 ( MIH_2015_by Women_1.pdf	Form
CMS-10398 #45 Maternal and Infant Health (MIH) Quality Screenshot #2 ( MIH_2015_by Women_2.pdf	Form
CMS-10398 #45 Maternal and Infant Health (MIH) Quality Screenshot #3 ( MIH_2015_by Women_3.pdf	Form
CMS-10398 #45 Maternal and Infant Health (MIH) Quality Screenshot #4 ( MIH_2015_by Women_4.pdf	Form
CMS-10398 #45 Maternal and Infant Health (MIH) Quality Screenshot #5 ( MIH_2015_by Women_5.pdf	Form
CMS-10398 #45 Maternal and Infant Health (MIH) Quality Screenshot #6 ( MIH_2015_by Women_6.pdf	Form
CMS-10398 #45 Maternal and Infant Health (MIH) Quality Screenshot #1 ( MIH_2015_Postpartum Women_1.pdf	Form
CMS-10398 #45 Maternal and Infant Health (MIH) Quality Screenshot #2 ( MIH_2015_Postpartum Women_2.pdf	Form
CMS-10398 #45 Maternal and Infant Health (MIH) Quality Screenshot #3 ( MIH_2015_Postpartum Women_3.pdf	Form
CMS-10398 #45 Maternal and Infant Health (MIH) Quality Screenshot #4 ( MIH_2015_Postpartum Women_4.pdf	Form
CMS-10398 #45 Maternal and Infant Health (MIH) Quality Screenshot #5 ( MIH_2015_Postpartum Women_5.pdf	Form
CMS-10398 #45 Maternal and Infant Health (MIH) Quality Screenshot #6 ( MIH_2015_Postpartum Women_6.pdf	Form
CMS-10398 #45 Maternal and Infant Health (MIH) Quality Screenshot #7 ( MIH_2015_Postpartum Women_7.pdf	Form
CMS-10398 #45 Maternal and Infant Health (MIH) Quality Screenshot #8 ( MIH_2015_Postpartum Women_8.pdf	Form
CMS-10398 #45 Maternal and Infant Health (MIH) Quality Screenshot #9 ( MIH_2015_Postpartum Women_9.pdf	Form
CMS-10398 #45 Maternal and Infant Health (MIH) Quality Screenshot #10 MIH_2015_Postpartum Women_10.pdf	Form
45 - Supporting Statement MIH Quality.docx #45 - Supporting Statement	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

GenIC #45 (Extension w/o change): Maternal and Infant Health Quality

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10398 #45	Maternal and Infant Health (MIH) Quality Screenshot #1 (Women)	MIH_2015_by Women_1.pdf	Yes	Yes	Fillable Fileable
Form	CMS-10398 #45	Maternal and Infant Health (MIH) Quality Screenshot #3 (Women)	MIH_2015_by Women_3.pdf	Yes	Yes	Fillable Fileable
Form	CMS-10398 #45	Maternal and Infant Health (MIH) Quality Screenshot #1 (Postpartum Women)	MIH_2015_Postpartum Women_1.pdf	Yes	Yes	Fillable Fileable
Form	CMS-10398 #45	Maternal and Infant Health (MIH) Quality Screenshot #6 (Women)	MIH_2015_by Women_6.pdf	Yes	Yes	Fillable Fileable
Form	CMS-10398 #45	Maternal and Infant Health (MIH) Quality Screenshot #2 (Postpartum Women)	MIH_2015_Postpartum Women_2.pdf	Yes	Yes	Fillable Fileable
Form	CMS-10398 #45	Maternal and Infant Health (MIH) Quality Screenshot #3 (Postpartum Women)	MIH_2015_Postpartum Women_3.pdf	Yes	Yes	Fillable Fileable
Form	CMS-10398 #45	Maternal and Infant Health (MIH) Quality Screenshot #4 (Postpartum Women)	MIH_2015_Postpartum Women_4.pdf	Yes	Yes	Fillable Fileable
Form	CMS-10398 #45	Maternal and Infant Health (MIH) Quality Screenshot #5 (Postpartum Women)	MIH_2015_Postpartum Women_5.pdf	Yes	Yes	Fillable Fileable
Form	CMS-10398 #45	Maternal and Infant Health (MIH) Quality Screenshot #6 (Postpartum Women)	MIH_2015_Postpartum Women_6.pdf	Yes	Yes	Fillable Fileable
Form	CMS-10398 #45	Maternal and Infant Health (MIH) Quality Screenshot #7 (Postpartum Women)	MIH_2015_Postpartum Women_7.pdf	Yes	Yes	Fillable Fileable
Form	CMS-10398 #45	Maternal and Infant Health (MIH) Quality Screenshot #8 (Postpartum Women)	MIH_2015_Postpartum Women_8.pdf	Yes	Yes	Fillable Fileable
Form	CMS-10398 #45	Maternal and Infant Health (MIH) Quality Screenshot #9 (Postpartum Women)	MIH_2015_Postpartum Women_9.pdf	Yes	Yes	Fillable Fileable
Form	CMS-10398 #45	Maternal and Infant Health (MIH) Quality Screenshot #10 (Postpartum Women)	MIH_2015_Postpartum Women_10.pdf	Yes	Yes	Fillable Fileable
Form	CMS-10398 #45	Maternal and Infant Health (MIH) Quality Screenshot #2 (Women)	MIH_2015_by Women_2.pdf	Yes	Yes	Fillable Fileable
Form	CMS-10398 #45	Maternal and Infant Health (MIH) Quality Screenshot #4 (Women)	MIH_2015_by Women_4.pdf	Yes	Yes	Fillable Fileable
Form	CMS-10398 #45	Maternal and Infant Health (MIH) Quality Screenshot #5 (Women)	MIH_2015_by Women_5.pdf	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

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	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
#45 - Supporting Statement	45 - Supporting Statement MIH Quality.docx	01/12/2018

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