Information Collection Request

State Medicaid Eligibility Quality Control Sample Selection Lists and Supporting Regulations

ICR 202010-0938-008 · OMB 0938-0147 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
CMS 319 - Supporting Statement Part A - Final.docx Supporting Statement A Uploaded 2020-10-13 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
43652 State Medicaid Eligibility Quality Control Sample Selection Lists and Supporting Regulations at 42 CFR 431.800 - 431.865 Modified

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved
646 0
64,600 0
0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
State Medicaid Eligibility Quality Control Sample Selection Lists and Supporting Regulations at 42 CFR 431.800 - 431.865

table that charts list of burden
  Total Request 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 646 0 0 0 526 120
Annual Time Burden (Hours) 64,600 0 0 0 63,640 960
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No