Information Collection Request
Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (CMS-10184)
ICR 202405-0938-026 · OMB 0938-1012 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1012 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10184 Summary of Eligibility and Payment Review Findings |
Form and Instruction | Removed | Repair queued |
| Form CMS-10184 Reporting Individual Payment Findings |
Form | Removed | Repair queued |
| Form CMS-10184 Reporting Individual Review Findings |
Form | Removed | Repair queued |
| Form CMS-10184 Monthly Sampling Lists |
Form | Removed | Missing upstream |
| Form CMS-10184 Reinstatement of Prior Burden Estimates for CMS-10184E |
Form and Instruction | Removed | Repair queued |
| Form CMS-10184 Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (MEQC Substitution) |
Form and Instruction | Removed | Repair queued |
 CMS - 10184 - Supporting Statement - Part B - Eligibility.docx |
Supporting Statement B | Uploaded 2024-05-24 | Repair queued |
| CMS - 10184 - Supporting Statement - Part A - Eligibility_PERM 5-22-24.docx |
Supporting Statement A | Uploaded 2024-05-24 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 46149 |  Corrective Action Report |
Modified | ||
| 46148 | Summary of Eligibility and Payment Review Findings |
Form and Instruction | Removed | |
| 46147 | Reporting Individual Payment Findings |
Form | Removed | |
| 46146 | Reporting Individual Review Findings |
Form | Removed | |
| 46145 | Communications and Review Support |
Modified | ||
| 46144 | Monthly Sampling Lists |
Form | Removed | |
| 46143 | Pre-cycle Report |
Modified | ||
| 193769 | Reinstatement of Prior Burden Estimates for CMS-10184E |
Form and Instruction | Removed | |
| 190303 | Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (MEQC Substitution) |
Form and Instruction | Removed |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1012 |
| Type of Information Collection | Reinstatement with change of a previously approved collection |
| Previous ICR Reference No | 201609-0938-031 |
| Agency Tracking No | OFM -- IPPS |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |