Information Collection

[Medicaid] GenIC #94 (New): Streamlining Medicaid Enterprise Systems (MES) Advance Planning Documents (APD) Templates

IC 276836 under ICR 202409-0938-028 · OMB 0938-1148.

⚠️ Notice: This information collection may be referencing outdated material.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

2026-07-30 - Revision of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form GenIC #94 MES APD Template [Medicaid] GenIC #94 (New): Streamlining Medicaid Enterprise Systems (MES) Advance Planning Documents (APD) Templates	Form and Instruction
Form GenIC #94 MES OAPD Template [Medicaid] GenIC #94 (New): Streamlining Medicaid Enterprise Systems (MES) Advance Planning Documents (APD) Templates	Form and Instruction
Form GenIC #94 AoA Template [Medicaid] GenIC #94 (New): Streamlining Medicaid Enterprise Systems (MES) Advance Planning Documents (APD) Templates	Form and Instruction
Form GenIC #94 MES MDBT+CHIP Template [Medicaid] GenIC #94 (New): Streamlining Medicaid Enterprise Systems (MES) Advance Planning Documents (APD) Templates	Form and Instruction
Form GenIC #94 MES RFP Checklist [Medicaid] GenIC #94 (New): Streamlining Medicaid Enterprise Systems (MES) Advance Planning Documents (APD) Templates	Form and Instruction
Form GenIC #94 Operational Report Workbook [Medicaid] GenIC #94 (New): Streamlining Medicaid Enterprise Systems (MES) Advance Planning Documents (APD) Templates	Form and Instruction
Form GenIC #94 MES Project Status Report [Medicaid] GenIC #94 (New): Streamlining Medicaid Enterprise Systems (MES) Advance Planning Documents (APD) Templates	Form and Instruction
Form GenIC #94 Intake Form [Medicaid] GenIC #94 (New): Streamlining Medicaid Enterprise Systems (MES) Advance Planning Documents (APD) Templates	Form and Instruction
GenIC #94 MES APD Template MES APD Template.pdf	Form and Instruction
GenIC #94 MES OAPD Template MES OAPD Template.pdf	Form and Instruction
GenIC #94 AoA Template AoA Template.pdf	Form and Instruction
GenIC #94 MES MDBT+CHIP Template MES MDBT+CHIP.pdf	Form and Instruction
GenIC #94 MES RFP Checklist MES RFP Checklist.pdf	Form and Instruction
GenIC #94 Operational Report Workbook Operational Report Workbook.pdf	Form and Instruction
GenIC #94 MES Project Status Report MES Project Status Report.pdf	Form and Instruction
GenIC #94 Intake Form Intake Form.pdf	Form and Instruction
20250508 E&E to MES APD Template Crosswalk.pdf CROSSWALK - MES APD Template	IC Document
SHO #25-003 Letter.pdf SHO letter (2025-003): Streamlining Medicaid Enterprise Systems (MES) Templates to Improve Monitoring and Oversight to Ensure Fi	IC Document
GenIC 94 - Generic Supporting Statement (2025 version 18).docx Generic Supporting Statement	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

[Medicaid] GenIC #94 (New): Streamlining Medicaid Enterprise Systems (MES) Advance Planning Documents (APD) Templates

Agency IC Tracking Number:

CMCS

IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	GenIC #94	Yes	Yes	Fillable Fileable
Form and Instruction	GenIC #94	Yes	Yes	Fillable Fileable
Form and Instruction	GenIC #94	Yes	Yes	Fillable Fileable
Form and Instruction	GenIC #94	Yes	Yes	Fillable Fileable
Form and Instruction	GenIC #94	Yes	Yes	Fillable Fileable
Form and Instruction	GenIC #94	Yes	Yes	Fillable Fileable
Form and Instruction	GenIC #94	Yes	Yes	Fillable Fileable
Form and Instruction	GenIC #94	Yes	Yes	Fillable Fileable

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: 56

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
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,314	3,314
Annual IC Time Burden (Hours)	86,096	86,096
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CROSSWALK - MES APD Template		09/03/2025
SHO letter (2025-003): Streamlining Medicaid Enterprise Systems (MES) Templates to Improve Monitoring and Oversight to Ensure Fiscal Integrity		09/03/2025
Generic Supporting Statement		09/03/2025

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

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