OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

GenIC #64 (Revision) Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: Federal Meta-Analysis Support

IC 252244 under ICR 202401-0938-016 · OMB 0938-1148.

Documents and Forms
Document Name
Document Type
Other-Introductory Email (from CMS t
Other-Introductory Email (from CMS t
Other-Introductory Email (from RTI t
Other-Introductory Email (from RTI t
Other-Introductory Email (from State
Other-Introductory Email (from State
Other-Interview Email Invitation
Other-Interview Email Invitation
Other-Interview Outlook Invitation
Other-Interview Outlook Invitation
Other-Interview Confirmation Email
Other-Interview Confirmation Email
Other-Thank You Email
Other-Thank You Email
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

GenIC #64 (Revision) Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: Federal Meta-Analysis Support CMCS
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Introductory Email (from CMS to State Medicaid Director) Attachment 3.a. MCO-BH Administrator Interview Introductory Email to SMD from CMS.pdf Yes Yes Fillable Fileable
Other-Introductory Email (from RTI to State Medicaid Director) Attachment 3.b. MCO-BH Administrator Interview Introductory Email to SMD from RTI_DDME.pdf Yes Yes Fillable Fileable
Other-Introductory Email (from State Medicaid Director) Attachment 3.c. MCO.BH Administrator Introductory Email from SMD.pdf Yes Yes Fillable Fileable
Other-Interview Email Invitation Attachment 3.d. MCO-BH Administrator Interview Introductory Email.pdf Yes Yes Fillable Fileable
Other-Interview Outlook Invitation Attachment 3.e. MCO.BH Administrator Interview Outlook Invitation_clean.pdf Yes Yes Fillable Fileable
Other-Interview Confirmation Email Attachment 3.f. MCO.BH Administrator Interview Confirmation Email_clean.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10398 #64 MCO Protocol with Instructions Attachment 3.g. OMB.MCO_interview_protocol_CMSComments_RTI_CLEAN2_12.14.21.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10398 $64 Behavioral Health Stakeholder Interview Protocol with Instructions (Residential Providers) Attachment 3.h. OMB.BH_interview_residential_protocol_CMSComments_RTI_clean_12.14.21.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10398 (#64) Behavioral Health Stakeholder Interview Protocol with Instructions (Non-Residential Providers) Attachment 3.i. OMB.BH_interview_NONresidential_protocol_CMSComments_RTI_clean_12.14.21.pdf Yes Yes Fillable Fileable
Other-Thank You Email Attachment 3.j. MCO.BH Administrator.Thank you note .pdf Yes Yes Fillable Fileable

Health Health Care Services

 

90 0
   
Private Sector Businesses or other for-profits
 
   100 %

  Requested 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 90 0 0 0 0 90
Annual IC Time Burden (Hours) 5 0 0 0 0 5
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Generic Supporting Statement 64 - Generic Supporting Statement (2022 version 6).docx 03/18/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.