Information Collection

Medicaid Managed Care: States

IC 261963 under ICR 202405-0938-011 · OMB 0938-1453.

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Information Collection (IC) Details

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IC Title:	Medicaid Managed Care: States	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 438.7 42 CFR 438.16 42 CFR 438.6 42 CFR 438.66 42 CFR 438.68 42 CFR 438.74 42 CFR 438.207 42 CFR 438.608 42 CFR 438.3 42 CFR 438.10

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 49	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,383	3,383
Annual IC Time Burden (Hours)	97,549	97,549
Annual IC Cost Burden (Dollars)	0	0

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