OMB.report

Federal forms, ICRs, and supporting documents

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

IC 260938 under ICR 202401-0938-016 · OMB 0938-1148.

Documents and Forms
Document Name
Document Type
Other-Demonstration Characteristics
Other-Demonstration Characteristics
Other-Demonstration Characteristics
Other-Demonstration Characteristics
Instruction
Instruction
Other-Demonstration Characteristics
Other-Demonstration Characteristics
Other-Demonstration Characteristics
Other-Demonstration Characteristics
Other-Demonstration Characteristics
Other-Demonstration Characteristics
Other-Implementation Interview Intro
Other-Implementation Interview Intro
Other-Implementation Interview Email
Other-Implementation Interview Email
Other-Implementation Interview Confi
Other-Implementation Interview Confi
Other-Implementation Interview Outlo
Other-Implementation Interview Outlo
Other-Implementation Interview Remin
Other-Implementation Interview Remin
Instruction
Instruction
Other-MCO and Behavioral Health Stak
Other-MCO and Behavioral Health Stak
Other-MCO and Behavioral Health Prov
Other-MCO and Behavioral Health Prov
Other-MCO and Behavioral Health Prov
Other-MCO and Behavioral Health Prov
Other-MCO and Behavioral Health Prov
Other-MCO and Behavioral Health Prov
Other-MCO and Behavioral Health Prov
Other-MCO and Behavioral Health Prov
Other-MCO and Behavioral Health Prov
Other-MCO and Behavioral Health Prov
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Other-MCO and Behavioral Health Prov
Other-MCO and Behavioral Health Prov
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

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

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Demonstration Characteristics Interview Introductory Email 64 - Attachment 1.a. Demo Characteristics Admin Intro Email from CMS to SMD_clean.docx Yes Yes Printable Only
Other-Demonstration Characteristics Interview Email Invitation with Program Characteristics Grid Attachment 1.b. Demonstration Characteristics Interview Email Invitation_clean_ 5June 2020.docx Yes Yes Fillable Fileable
Instruction Attachment 1.c. Demonstration Characteristics Interview Questions_clean_5 June 2020.docx No   Printable Only
Other-Demonstration Characteristics Interview Confirmation Email 64 - Attachment 1.d. Demo Characteristics Interview Confirmation Email_clean.docx Yes No Printable Only
Other-Demonstration Characteristics Interview Outlook Invitation 64 - Attachment 1.e. Demo Characteristics Interview Outlook Invitation_clean.docx Yes No Printable Only
Other-Demonstration Characteristics Interview Reminder Email 64 - Attachment 1.f. Demonstration Characteristics Interview Reminder Email_clean.docx Yes No Printable Only
Other-Implementation Interview Introductory Email from CMS to State Medicaid Director and Single State Substance Abuse Agency Director 64 - Attachment 2.a. Email CMS to State Administrator Intro RTI Evaluation_clean.docx Yes No Printable Only
Other-Implementation Interview Email Invitation 64 - Attachment 2.b. Implementation Interview Email Invitation_clean.docx Yes No Printable Only
Other-Implementation Interview Confirmation Email 64 - Attachment 2.c. Implementation Interview Confirmation Email_clean.docx Yes No Printable Only
Other-Implementation Interview Outlook Invitation 64 - Attachment 2.d. Implementation Interview Outlook Invitation_clean.docx Yes No Printable Only
Other-Implementation Interview Reminder Email 64 - Attachment 2.e. Implementation Interview Reminder Email_clean.docx Yes No Printable Only
Instruction Attachment 2.f. Implementation Interview Protocol with Instructions for Interviewer_clean_5 June 2020.docx No   Printable Only
Other-MCO and Behavioral Health Stakeholder Interview Introductory Email from CMS to State Medicaid Director Attachment 3.a. MCO-BH Administrator Interview Introductory Email to SMD from CMS.pdf Yes No Printable Only
Other-MCO and Behavioral Health Provider Stakeholder Interview Introductory Email from RTI to State Medicaid Director Attachment 3.b. MCO-BH Administrator Interview Introductory Email to SMD from RTI_DDME.pdf Yes No Printable Only
Other-MCO and Behavioral Health Provider Stakeholder Interview Introductory Email from State Medicaid Director Attachment 3.c. MCO.BH Administrator Introductory Email from SMD.pdf Yes No Printable Only
Other-MCO and Behavioral Health Provider Stakeholder Interview Email Invitation Attachment 3.d. MCO-BH Administrator Interview Introductory Email.pdf Yes No Printable Only
Other-MCO and Behavioral Health Provider Stakeholder Interview Outlook Invitation Attachment 3.e. MCO.BH Administrator Interview Outlook Invitation_clean.pdf Yes No Printable Only
Other-MCO and Behavioral Health Provider Stakeholder Interview Confirmation Email Attachment 3.f. MCO.BH Administrator Interview Confirmation Email_clean.pdf Yes No Printable Only
Instruction Attachment 3.g. OMB.MCO_interview_protocol_CMSComments_RTI_CLEAN2_12.14.21.pdf No   Printable Only
Instruction Attachment 3.h. OMB.BH_interview_residential_protocol_CMSComments_RTI_clean_12.14.21.pdf No   Printable Only
Instruction Attachment 3.i. OMB.BH_interview_NONresidential_protocol_CMSComments_RTI_clean_12.14.21.pdf No   Printable Only
Other-MCO and Behavioral Health Provider Stakeholder Interview Thank You Email Attachment 3.j. MCO.BH Administrator.Thank you note .pdf Yes No Printable Only

Health Health Care Services

 

60 0
   
State, Local, and Tribal Governments
 
   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 340 0 0 0 0 340
Annual IC Time Burden (Hours) 405 0 0 0 0 405
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Generic Supporting Statement 64 - Generic Supporting Statement (2023 version 8).docx 07/06/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.