Information Collection Request

Medicaid and CHIP Program (MACPro) (CMS-10434)

ICR 201908-0938-015 · OMB 0938-1188 · Active

ICR Details

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  Inventory as of this Action Requested Previously Approved
07/31/2023 36 Months From Approved 07/31/2020
280 0 280
96,844 0 96,844
0 0 0





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IC Title Form No. Form Name
GenIC #2 (Extension) - CHIP State Plan Eligibility CMS-10434 #2 CHIP State Plan Eligibility
GenIC # 45 (Extension) - Maternal and Infant Health Quality CMS-10434 #45 Maternal and Infant Health
GenIC #26 (Extension) - Medicaid Adult and Child Core Set Measures 390-CQM 2018-CCW-CH-PRA-D, 385-CQM 2018-ADD-CH-PRA-D, 245-QSSI-MACPro-PRA-AdditionalNotes-D, 385-CQM 2018-ADD-CH-PRA-D, 429-AQM 2018 ABA-AD PRA-D CQM 2018 - Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication (ADD-CH) Core Measure PRA Document ,   AQM 2018 – Adult Body Mass Index Assessment (ABA) Core Measure PRA document ,   Contraceptive Care – All Women Ages 15-20 (CCW-CH) ,   CQM 2018 - Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication (ADD-CH) Core Measure PRA Document ,   AQM, CQM & MIH - Additional Notes PRA document
GenIC #47 (Extension) - Health Home Core Sets CMS-10434 #47 Health Home Core Set
GenIC #22 (Extension) - Health Home State Plan Amendment (SPA) CMS-10434 #22 Health Homes
GenIC #1 (Extension) - Initial Application CMS-10434 #1, CMS-10434 #1, CMS-10434 #1 Initial Application Combined ,   Initial Application SPA Admin ,   Initial Application
GenIC #15 (Extension) - Medicaid State Plan Eligibility CMS-10434 #15 Medicaid State Plan Eligibility
GenIC #3 (Extension) - Alternative Benefit Plans (ABPs) CMS-10434 #3 ABP

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 280 280 0 0 0 0
Annual Time Burden (Hours) 96,844 96,844 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


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