Information Collection

[Medicaid] GenIC #64 (Revision) Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: Federal Meta Analysis

IC 277992 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⚠️ Notice: This information collection may be referencing outdated material.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 1a Characteristics/Implementation Introductory Email [Medicaid] GenIC #64 (Revision) Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: Federal Meta Analysis	Form
Form 1b Characteristics/Implementation Interview Email Invitation with Program Characteristics Grid [Medicaid] GenIC #64 (Revision) Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: Federal Meta Analysis	Form
Form 1c Interview Questions [Medicaid] GenIC #64 (Revision) Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: Federal Meta Analysis	Form and Instruction
Form 1d Characteristics/Implementation Confirmation Email [Medicaid] GenIC #64 (Revision) Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: Federal Meta Analysis	Form
Form 1e Characteristics/Implementation Interview Invitation [Medicaid] GenIC #64 (Revision) Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: Federal Meta Analysis	Form
Form 1f Characteristics/Implementation Interview Reminder Email [Medicaid] GenIC #64 (Revision) Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: Federal Meta Analysis	Form
Form 1g Characteristics/Implementation Interview Thank You Email [Medicaid] GenIC #64 (Revision) Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: Federal Meta Analysis	Form
Form 3a MCO and Behavioral Health Stakeholder Interview Introductory Email [Medicaid] GenIC #64 (Revision) Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: Federal Meta Analysis	Form
Form 3b MCO and Behavioral Health Provider Stakeholder Interview Introductory Email [Medicaid] GenIC #64 (Revision) Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: Federal Meta Analysis	Form
Form 3c MCO and Behavioral Health Provider Stakeholder Interview Introductory Email [Medicaid] GenIC #64 (Revision) Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: Federal Meta Analysis	Form
Form 3d MCO and Behavioral Health Provider Stakeholder Interview Email Invitation [Medicaid] GenIC #64 (Revision) Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: Federal Meta Analysis	Form
Form 3e MCO and Behavioral Health Provider Stakeholder Interview Outlook Invitation [Medicaid] GenIC #64 (Revision) Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: Federal Meta Analysis	Form
Form 3f MCO and Behavioral Health Provider Stakeholder Interview Confirmation Email [Medicaid] GenIC #64 (Revision) Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: Federal Meta Analysis	Form
Form 3g MCO Protocol with Instructions [Medicaid] GenIC #64 (Revision) Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: Federal Meta Analysis	Form and Instruction
Form 3h Behavioral Health Stakeholder Interview Protocol with Instructions (Residential Providers) [Medicaid] GenIC #64 (Revision) Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: Federal Meta Analysis	Form and Instruction
Form 3i Behavioral Health Stakeholder Interview Protocol with Instructions (Non-Residential Providers) [Medicaid] GenIC #64 (Revision) Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: Federal Meta Analysis	Form and Instruction
Form 3j MCO and Behavioral Health Provider Stakeholder Interview Thank You Email [Medicaid] GenIC #64 (Revision) Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: Federal Meta Analysis	Form
Form 4a Follow-Up Implementation Interview Introductory Email [Medicaid] GenIC #64 (Revision) Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: Federal Meta Analysis	Form
Form 4b Follow-Up Implementation Interview Email Invitation [Medicaid] GenIC #64 (Revision) Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: Federal Meta Analysis	Form
Form 4c Follow-Up Implementation Interview Confirmation Email [Medicaid] GenIC #64 (Revision) Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: Federal Meta Analysis	Form
Form 4d Follow-Up Implementation Interview Outlook Invitation [Medicaid] GenIC #64 (Revision) Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: Federal Meta Analysis	Form
Form 4e Follow-Up Implementation Interview Reminder Email [Medicaid] GenIC #64 (Revision) Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: Federal Meta Analysis	Form
Form 4f Follow-Up Implementation Interview Protocol with Instructions [Medicaid] GenIC #64 (Revision) Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: Federal Meta Analysis	Form and Instruction
Form 4g Follow-Up Implementation Interview Thank You Email [Medicaid] GenIC #64 (Revision) Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: Federal Meta Analysis	Form
1a Characteristics/Implementation Introductory Email Attachment1aDemonstrationCharacteristicsandImplementationAdministratorIntroEmail.docx	Form
1b Characteristics/Implementation Interview Email Invitatio Attachment1bDemonstrationCharacteristicsandImplementationInterviewEmailInvitation.docx	Form
1c Interview Questions Attachment1cDemonstrationCharacteristicsandImplementationInterviewQuestions.docx	Form and Instruction
1d Characteristics/Implementation Confirmation Email Attachment1dDemonstrationCharacteristicsandImplementationInterviewConfirmationEmail.docx	Form
1e Characteristics/Implementation Interview Invitation Attachment1eDemonstrationCharacteristicsandImplementationInterviewOutlookInvitation.docx	Form
1f Characteristics/Implementation Interview Reminder Email Attachment1fDemonstrationCharacteristicsandImplementationInterviewReminderEmail.docx	Form
1g Characteristics/Implementation Interview Thank You Email Attachment1gDemonstrationCharacteristicsandImplementationInterviewThankYouEmail.docx	Form
3a MCO and Behavioral Health Stakeholder Interview Introduc Attachment3aMCO-BHStakeholderInterviewIntroductoryEmailtoSMDfromCMS.docx	Form
3b MCO and Behavioral Health Provider Stakeholder Interview Attachment3bMCO-BHStakeholderInterviewIntroductoryEmailtoSMDfromRTI.docx	Form
3c MCO and Behavioral Health Provider Stakeholder Interview Attachment3cMCO-BHStakeholderInterviewIntroductoryEmailfromSMD.docx	Form
3d MCO and Behavioral Health Provider Stakeholder Interview Attachment3dMCO-BHStakeholderInterviewEmailInvitation.docx	Form
3e MCO and Behavioral Health Provider Stakeholder Interview Attachment3eMCO-BHStakeholderInterviewOutlookInvitation.docx	Form
3f MCO and Behavioral Health Provider Stakeholder Interview Attachment3fMCO-BHStakeholderInterviewConfirmationEmail.docx	Form
3g MCO Protocol with Instructions Attachment3gMCOProtocolwithInstructions.docx	Form and Instruction
3h Behavioral Health Stakeholder Interview Protocol with In Attachment3hBHStakeholderInterviewProtocolwithInstructions-Residential.docx	Form and Instruction
3i Behavioral Health Stakeholder Interview Protocol with In Attachment3iBHStakeholderInterviewProtocolwithInstructions-Nonresidential.docx	Form and Instruction
3j MCO and Behavioral Health Provider Stakeholder Interview Attachment3jMCO-BHStakeholderInterviewThankYouEmail.docx	Form
4a Follow-Up Implementation Interview Introductory Email Attachment4aFollow-upImplementationInterviewIntroductoryEmailfromCMStoSMD.docx	Form
4b Follow-Up Implementation Interview Email Invitation Attachment4bFollow-upImplementationInterviewEmailInvitation.docx	Form
4c Follow-Up Implementation Interview Confirmation Email Attachment4cFollow-upImplementationInterviewConfirmationEmail.docx	Form
4d Follow-Up Implementation Interview Outlook Invitation Attachment4dFollow-upImplementationInterviewOutlookInvitationText.docx	Form
4e Follow-Up Implementation Interview Reminder Email Attachment4eFollow-upImplementationInterviewReminderEmail.docx	Form
4f Follow-Up Implementation Interview Protocol with Instruc Attachment4fFollow-upImplementationInterviewProtocol.docx	Form and Instruction
4g Follow-Up Implementation Interview Thank You Email Attachment4gFollow-upImplementationInterviewThankYouEmail.docx	Form
GenIC 64 -Generic-Supporting-Statement (2026 version 14).docx Generic Supporting Statement	IC Document
Comment - mfd-c5t8-7w1y.pdf Public Comment (Anonymous)	IC Document
Response-to-Public-Comments.pdf Response to Public Comments	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

[Medicaid] GenIC #64 (Revision) Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: Federal Meta Analysis

Agency IC Tracking Number:

CMCS

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1a	Yes	Yes	Fillable Fileable
Form	1b	Yes	Yes	Fillable Fileable
Form and Instruction	1c	No		Printable Only
Form	1d	Yes	Yes	Fillable Fileable
Form	1e	Yes	Yes	Fillable Fileable
Form	1f	Yes	Yes	Fillable Fileable
Form	1g	Yes	Yes	Fillable Fileable
Form	3a	Yes	Yes	Fillable Fileable
Form	3b	Yes	Yes	Fillable Fileable
Form	3c	Yes	Yes	Fillable Fileable
Form	3d	Yes	Yes	Fillable Fileable
Form	3e	Yes	Yes	Fillable Fileable
Form	3f	Yes	Yes	Fillable Fileable
Form and Instruction	3g	Yes	Yes	Fillable Fileable
Form and Instruction	3h	Yes	Yes	Fillable Fileable
Form and Instruction	3i	Yes	Yes	Fillable Fileable
Form	3j	Yes	Yes	Fillable Fileable
Form	4a	Yes	Yes	Fillable Fileable
Form	4b	Yes	Yes	Fillable Fileable
Form	4c	Yes	Yes	Fillable Fileable
Form	4d	Yes	Yes	Fillable Fileable
Form	4e	Yes	Yes	Fillable Fileable
Form and Instruction	4f	Yes	Yes	Fillable Fileable
Form	4g	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: 211

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	384	384
Annual IC Time Burden (Hours)	506	506
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Supporting Statement		03/02/2026
Public Comment (Anonymous)		03/02/2026
Response to Public Comments		03/02/2026

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

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