OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Monthly State File of Medicaid/Medicare Dual Eligible Enrollees

IC 8816 under ICR 202310-0938-008 · OMB 0938-0958.

Documents and Forms
Document Name
Document Type
Instruction
Instruction
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

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

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction MAPD SUG 2018 to 2023 clean copy.docx https://www.cms.gov/files/document/mapd-state-user-guide-february-6-2023-version-110.pdf Yes Yes Printable Only

Health Health Care Services

Medicare Beneficiary Database (MBD)  80 FR 49237

51 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved 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
Track Change: User Guide MAPD SUG 2018 to 2023 tracked changes.docx 01/02/2024
Crosswalk: User Guide MAPD SUG Crosswalk 2018 TO 2023.xlsx 10/30/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.