Monthly State File of Medicaid/Medicare Dual Eligible Enrollees

Monthly State File of Medicaid/Medicare Dual Eligible Enrollees (CMS-10143)

OMB: 0938-0958

IC ID: 8816

Information Collection (IC) Details

View Information Collection (IC)

Monthly State File of Medicaid/Medicare Dual Eligible Enrollees
 
No Unchanged
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction MAPD State User Guide 2018 PRA.pdf www.cms.gov/Research-Statistics-Data-and-Systems/CMS-Information-Technology/mapdhelpdesk/Downloads/MAPD-State-User-Guide-Version-60.pdf Yes Yes Printable Only

Health Health Care Services

Medicare Beneficiary Database (MBD)  80 FR 49237

51 0
   
State, Local, and Tribal Governments
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 612 0 0 0 0 612
Annual IC Time Burden (Hours) 4,896 0 0 0 0 4,896
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk MMA File Crosswalk PRA 04 12 2018.xlsx 08/27/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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