Information Collection

GenIC #52 (Extension w/o change): Delivery System and Provider Payment Initiatives Under Medicaid Managed Care Products

IC 229740 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⚠️ Notice: This information collection may be referencing outdated material.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 #52 GenIC #52 (Extension w/o change): Delivery System and Provider Payment Initiatives Under Medicaid Managed Care Products	Form
CMS-10398 #52 Section 438.6(c) pre-print 52 - 438.6c Preprint - Clean Version_04_05_2017.docx	Form
52 - Supporting Statement Delivery System and Provider Payment Initiatives.docx #52 - Supporting Statement	IC Document

IC Title:

GenIC #52 (Extension w/o change): Delivery System and Provider Payment Initiatives Under Medicaid Managed Care Products

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	CMS-10398 #52	Section 438.6(c) pre-print	52 - 438.6c Preprint - Clean Version_04_05_2017.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 44

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	264	264
Annual IC Time Burden (Hours)	264	264
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
#52 - Supporting Statement	52 - Supporting Statement Delivery System and Provider Payment Initiatives.docx	01/12/2018

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