Information Collection

Medicaid Promoting Interoperability Program Document Templates

IC 192702 under ICR 202102-0938-009 · OMB 0938-1088.

Documents and Forms

Document Name Document Type
CMS-10292 HIT PAPD Template (2020 version 2).pdf Instruction
CMS-10292 HIT PAPD Template (2020 version 2).pdf Instruction
CMS-10292 State Medicaid HIT Plan Template (2020 version 2).pdf Instruction
CMS-10292 State Medicaid HIT Plan Template (2020 version 2).pdf Instruction
CMS-10292 Health Information Technology (HIT) Implementation Advan CMS-10292 HIT IAPD Template (2020 version 2).pdf Form and Instruction
CMS-10292 Health Information Technology (HIT) Implementation Advan CMS-10292 HIT IAPD Template (2020 version 2).pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Medicaid Promoting Interoperability Program Document Templates	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			CMS-10292 HIT PAPD Template (2020 version 2).pdf	Yes	Yes	Fillable Printable
Instruction			CMS-10292 State Medicaid HIT Plan Template (2020 version 2).pdf	Yes	Yes	Fillable Printable
Form and Instruction	CMS-10292	Health Information Technology (HIT) Implementation Advanced Planning Document (IAPD)	CMS-10292 HIT IAPD Template (2020 version 2).pdf	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 56	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	56	56
Annual IC Time Burden (Hours)	896	896
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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