Information Collection

(Private Sector) External Quality Review of Medicaid MCOs and Supporting Regulations in 42 CFR 438.360, 438.362, and 438.364

IC 216824 under ICR 202208-0938-011 · OMB 0938-0786.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0786 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-R-305 (Private Sector) External Quality Review of Medicaid MCOs and Supporting Regulations in 42 CFR 438.360, 438.362, and 438.364 Form and Instruction
CMS-R-305 External Quality Review (EQR) Protocols R4_CMS_2018_External_Quality_Review_Protocols_07262019.pdf Form and Instruction
CMS-R-305 External Quality Review (EQR) Protocols R4_CMS_2018_External_Quality_Review_Protocols_07262019.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	(Private Sector) External Quality Review of Medicaid MCOs and Supporting Regulations in 42 CFR 438.360, 438.362, and 438.364	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-R-305	External Quality Review (EQR) Protocols	R4_CMS_2018_External_Quality_Review_Protocols_07262019.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 659	Number of Respondents for Small Entity: 25

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	663	30	633
Annual IC Time Burden (Hours)	116,624	4,748	111,876
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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