Information Collection

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

IC 243372 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⚠️ Notice: This information collection may be referencing outdated material.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
4386c-Preprint-AppendixK-Example.docx	Other-Example
4386c-Preprint-COVID19-Example.docx	Other-Example
CMS-10398 #52 Section 438.6(c) Preprint 438.6(c) Revised Preprint Template_12 30 2020_ clean copy.docx	Form and Instruction
438.6(c) Crosswalk.xlsx Crosswalk - Section 438.6(c) Preprint	IC Document
GenIC 52 - Generic Supporting Statement (2020 version 5) Clean.docx Supporting Statement	IC Document

IC Title:

GenIC #52 (Revision) - 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
Other-Example			4386c-Preprint-AppendixK-Example.docx	Yes	No	Printable Only
Other-Example			4386c-Preprint-COVID19-Example.docx	Yes	No	Printable Only
Form and Instruction	CMS-10398 #52	Section 438.6(c) Preprint	438.6(c) Revised Preprint Template_12 30 2020_ clean copy.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	132	132
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
Crosswalk - Section 438.6(c) Preprint	438.6(c) Crosswalk.xlsx	08/28/2020
Supporting Statement	GenIC 52 - Generic Supporting Statement (2020 version 5) Clean.docx	01/05/2021

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