Information Collection

[Medicaid] GenIC #96 (New): Mental Health (MH) and Substance Use Disorder (SUD) Parity Reporting Tools

IC 280051 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⚠️ Notice: This information collection may be referencing outdated material.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:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10398 #96 Health Plan Reporting Template [Medicaid] GenIC #96 (New): Mental Health (MH) and Substance Use Disorder (SUD) Parity Reporting Tools	Form and Instruction
Form CMS-10398 #96 State Fee-for-Service (FFS) Program Reporting Template [Medicaid] GenIC #96 (New): Mental Health (MH) and Substance Use Disorder (SUD) Parity Reporting Tools	Form and Instruction
Form CMS-10398 #96 State Summary Template [Medicaid] GenIC #96 (New): Mental Health (MH) and Substance Use Disorder (SUD) Parity Reporting Tools	Form and Instruction
Instructional Guide for Health Plan-State FFS Reporting Template 2.28.25_.pdf	Instruction
Instructional Guide for Parity State Summary Template 2.28.25.pdf	Instruction
CMS-10398 #96 Health Plan Reporting Template Parity Health Plan Reporting Template 1.16.26..xlsx	Form and Instruction
CMS-10398 #96 State Fee-for-Service (FFS) Program Reporting Template Parity State FFS Program Reporting Template 1.16.26.xlsx	Form and Instruction
CMS-10398 #96 State Summary Template Parity State Summary Template 6.18.25.xlsx	Form and Instruction
GenIC 96 - Generic Supporting Statement (2025 version 14).docx Generic Supporting Statement	IC Document
0938-1148 - Gen IC - Mental Health (MH) and Substance Use Disorder (SUD) Parity Reporting Tools.pdf OMB Terms of Clearance	IC Document

IC Title:

[Medicaid] GenIC #96 (New): Mental Health (MH) and Substance Use Disorder (SUD) Parity Reporting Tools

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	CMS-10398 #96	Yes	Yes	Fillable Fileable
Instruction		Yes	Yes	Printable Only
Instruction		Yes	Yes	Printable Only
Form and Instruction	CMS-10398 #96	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10398 #96	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 566

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	93	93
Annual IC Time Burden (Hours)	6,074	6,074
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Supporting Statement		04/22/2026
OMB Terms of Clearance		06/04/2026

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

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