Information Collection

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

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1148 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
64 - Attachment 1.a. Demo Characteristics Admin Intro Email from CMS to SMD_clean.docx	Other-Demonstration Characteristics
64 - Attachment 1.a. Demo Characteristics Admin Intro Email from CMS to SMD_clean.docx	Other-Demonstration Characteristics
Attachment 1.b. Demonstration Characteristics Interview Email Invitation_clean_ 5June 2020.docx	Other-Demonstration Characteristics
Attachment 1.b. Demonstration Characteristics Interview Email Invitation_clean_ 5June 2020.docx	Other-Demonstration Characteristics
Attachment 1.c. Demonstration Characteristics Interview Questions_clean_5 June 2020.docx	Instruction
Attachment 1.c. Demonstration Characteristics Interview Questions_clean_5 June 2020.docx	Instruction
64 - Attachment 1.d. Demo Characteristics Interview Confirmation Email_clean.docx	Other-Demonstration Characteristics
64 - Attachment 1.d. Demo Characteristics Interview Confirmation Email_clean.docx	Other-Demonstration Characteristics
64 - Attachment 1.e. Demo Characteristics Interview Outlook Invitation_clean.docx	Other-Demonstration Characteristics
64 - Attachment 1.e. Demo Characteristics Interview Outlook Invitation_clean.docx	Other-Demonstration Characteristics
64 - Attachment 1.f. Demonstration Characteristics Interview Reminder Email_clean.docx	Other-Demonstration Characteristics
64 - Attachment 1.f. Demonstration Characteristics Interview Reminder Email_clean.docx	Other-Demonstration Characteristics
64 - Attachment 2.a. Email CMS to State Administrator Intro RTI Evaluation_clean.docx	Other-Implementation Interview Intro
64 - Attachment 2.a. Email CMS to State Administrator Intro RTI Evaluation_clean.docx	Other-Implementation Interview Intro
64 - Attachment 2.b. Implementation Interview Email Invitation_clean.docx	Other-Implementation Interview Email
64 - Attachment 2.b. Implementation Interview Email Invitation_clean.docx	Other-Implementation Interview Email
64 - Attachment 2.c. Implementation Interview Confirmation Email_clean.docx	Other-Implementation Interview Confi
64 - Attachment 2.c. Implementation Interview Confirmation Email_clean.docx	Other-Implementation Interview Confi
64 - Attachment 2.d. Implementation Interview Outlook Invitation_clean.docx	Other-Implementation Interview Outlo
64 - Attachment 2.d. Implementation Interview Outlook Invitation_clean.docx	Other-Implementation Interview Outlo
64 - Attachment 2.e. Implementation Interview Reminder Email_clean.docx	Other-Implementation Interview Remin
64 - Attachment 2.e. Implementation Interview Reminder Email_clean.docx	Other-Implementation Interview Remin
Attachment 2.f. Implementation Interview Protocol with Instructions for Interviewer_clean_5 June 2020.docx	Instruction
Attachment 2.f. Implementation Interview Protocol with Instructions for Interviewer_clean_5 June 2020.docx	Instruction
Attachment 3.a. MCO-BH Administrator Interview Introductory Email to SMD from CMS.pdf	Other-MCO and Behavioral Health Stak
Attachment 3.a. MCO-BH Administrator Interview Introductory Email to SMD from CMS.pdf	Other-MCO and Behavioral Health Stak
Attachment 3.b. MCO-BH Administrator Interview Introductory Email to SMD from RTI_DDME.pdf	Other-MCO and Behavioral Health Prov
Attachment 3.b. MCO-BH Administrator Interview Introductory Email to SMD from RTI_DDME.pdf	Other-MCO and Behavioral Health Prov
Attachment 3.c. MCO.BH Administrator Introductory Email from SMD.pdf	Other-MCO and Behavioral Health Prov
Attachment 3.c. MCO.BH Administrator Introductory Email from SMD.pdf	Other-MCO and Behavioral Health Prov
Attachment 3.d. MCO-BH Administrator Interview Introductory Email.pdf	Other-MCO and Behavioral Health Prov
Attachment 3.d. MCO-BH Administrator Interview Introductory Email.pdf	Other-MCO and Behavioral Health Prov
Attachment 3.e. MCO.BH Administrator Interview Outlook Invitation_clean.pdf	Other-MCO and Behavioral Health Prov
Attachment 3.e. MCO.BH Administrator Interview Outlook Invitation_clean.pdf	Other-MCO and Behavioral Health Prov
Attachment 3.f. MCO.BH Administrator Interview Confirmation Email_clean.pdf	Other-MCO and Behavioral Health Prov
Attachment 3.f. MCO.BH Administrator Interview Confirmation Email_clean.pdf	Other-MCO and Behavioral Health Prov
Attachment 3.g. OMB.MCO_interview_protocol_CMSComments_RTI_CLEAN2_12.14.21.pdf	Instruction
Attachment 3.g. OMB.MCO_interview_protocol_CMSComments_RTI_CLEAN2_12.14.21.pdf	Instruction
Attachment 3.h. OMB.BH_interview_residential_protocol_CMSComments_RTI_clean_12.14.21.pdf	Instruction
Attachment 3.h. OMB.BH_interview_residential_protocol_CMSComments_RTI_clean_12.14.21.pdf	Instruction
Attachment 3.i. OMB.BH_interview_NONresidential_protocol_CMSComments_RTI_clean_12.14.21.pdf	Instruction
Attachment 3.i. OMB.BH_interview_NONresidential_protocol_CMSComments_RTI_clean_12.14.21.pdf	Instruction
Attachment 3.j. MCO.BH Administrator.Thank you note .pdf	Other-MCO and Behavioral Health Prov
Attachment 3.j. MCO.BH Administrator.Thank you note .pdf	Other-MCO and Behavioral Health Prov
64 - Generic Supporting Statement (2023 version 8).docx Generic Supporting Statement	IC Document
64 - Generic Supporting Statement (2023 version 8).docx Generic Supporting Statement	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

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

Agency IC Tracking Number:

CMCS

IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	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

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	340	340
Annual IC Time Burden (Hours)	405	405
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.