Information Collection

GenIC #55 (New): Limit on Federal Financial Participation for Durable Medical Equipment in Medicaid

IC 231119 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⚠️ Notice: This information collection may be referencing outdated material.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 #55 GenIC #55 (New): Limit on Federal Financial Participation for Durable Medical Equipment in Medicaid	Form
Instructions for the State Fee Schedule Drop spreadsheet-3-20-18.docx	Instruction
CMS-10398 #55 State Fee Schedule Drop State Fee Schedule Drop-3-21-18.xlsx	Form
Crosswalk-DMEchanges-3-27-18.xlsx Crosswalk	IC Document
Instructions for the State Fee Schedule Drop spreadsheet-TRACK CHANGES.docx Instructions (Track Changes)	IC Document
1k2-917g-qdjy - Comment.pdf Public Comment: 1k2-917g-qdjy	IC Document
1k2-9138-nado - Comment.pdf Public Comment: 1k2-9138-nado	IC Document
1k2-9176-k8w4 - Combined Cover and Comment.pdf Public Comment: 1k2-9176-k8w4	IC Document
k2-9159-fleh - Combined Cover and Comment.pdf Public Comment: 1k2-9159-fleh	IC Document
GenIC #55 - Supporting Statement rev 04-18-2018 by OSORA PRA-CLEAN.docx Supporting Statement	IC Document
Letter to summarize the 60 day comments on DME limit on FFP collection of information.docx Response to 60-day Comments	IC Document

IC Title:

GenIC #55 (New): Limit on Federal Financial Participation for Durable Medical Equipment in Medicaid

Agency IC Tracking Number:

CMCS

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 #55	State Fee Schedule Drop	State Fee Schedule Drop-3-21-18.xlsx		Yes	Yes	Fillable Fileable
Instruction			Instructions for the State Fee Schedule Drop spreadsheet-3-20-18.docx		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
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	56	56
Annual IC Time Burden (Hours)	448	448
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Crosswalk	Crosswalk-DMEchanges-3-27-18.xlsx	04/18/2018
Instructions (Track Changes)	Instructions for the State Fee Schedule Drop spreadsheet-TRACK CHANGES.docx	04/18/2018
Public Comment: 1k2-917g-qdjy	1k2-917g-qdjy - Comment.pdf	04/18/2018
Public Comment: 1k2-9138-nado	1k2-9138-nado - Comment.pdf	04/18/2018
Public Comment: 1k2-9176-k8w4	1k2-9176-k8w4 - Combined Cover and Comment.pdf	04/18/2018
Public Comment: 1k2-9159-fleh	k2-9159-fleh - Combined Cover and Comment.pdf	04/18/2018
Supporting Statement	GenIC #55 - Supporting Statement rev 04-18-2018 by OSORA PRA-CLEAN.docx	04/18/2018
Response to 60-day Comments	Letter to summarize the 60 day comments on DME limit on FFP collection of information.docx	04/18/2018

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