Information Collection

GenIC #52 (Revised): Delivery System and Provider Payment Initiatives Under Medicaid Managed Care Products

IC 241795 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⚠️ Notice: This information collection may be referencing outdated material.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 (Revised): Delivery System and Provider Payment Initiatives Under Medicaid Managed Care Products	Form
438.6c_Preprint_COVID19 Example.docx	Other-Pre-print Example: COVID19
438.6c_Preprint_Appendix K Example.docx	Other-Pre-print Example: Appendix K
CMS-10398 #52 Section 438.6(c) pre-print 438-preprint-508 compliant.pdf	Form
52 - Supporting Statement Delivery System and Provider Payment Initiatives (2020 version 3).docx Generic Supporting Statement	IC Document

IC Title:

GenIC #52 (Revised): Delivery System and Provider Payment Initiatives Under Medicaid Managed Care Products

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10398 #52	Section 438.6(c) pre-print	438-preprint-508 compliant.pdf	Yes	Yes	Fillable Fileable
Other-Pre-print Example: COVID19			438.6c_Preprint_COVID19 Example.docx	Yes	Yes	Fillable Fileable
Other-Pre-print Example: Appendix K			438.6c_Preprint_Appendix K Example.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
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	264	264
Annual IC Time Burden (Hours)	5	5
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Supporting Statement	52 - Supporting Statement Delivery System and Provider Payment Initiatives (2020 version 3).docx	05/12/2020

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