GenIC #82 (unchanged from MACPro): Quality Improvement Affinity Group Expression of Interest Form

[Medicaid] Generic Clearance for Medicaid and CHIP State Plan, Waiver, and Program Submissions (CMS-10398)

Documents and Forms

Document Name Document Type
Form GenIC #82 GenIC #82 (unchanged from MACPro): Quality Improvement Affinity Group Expression of Interest Form Form and Instruction
GenIC #82 Quality Improvement Affinity Group Expression of Interes GenIC 82 - 508UniversalEOI (2024 version 3).docx Form and Instruction
GenIC #82 Quality Improvement Affinity Group Expression of Interes GenIC 82 - 508UniversalEOI (2024 version 3).docx Form and Instruction

Information Collection (IC) Details

IC Title:	GenIC #82 (unchanged from MACPro): Quality Improvement Affinity Group Expression of Interest Form	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	GenIC #82	Quality Improvement Affinity Group Expression of Interest Form	GenIC 82 - 508UniversalEOI (2024 version 3).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	60	60
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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