OMB control number

Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (CMS-10184)

OMB 0938-1012 · HHS/CMS.

OMB 0938-1012

The Improper Payments Information Act (IPIA) of 2002 requires CMS to produce national error rates for Medicaid and SCHIP. To comply with the IPIA, CMS needs the information to be collected in order to provide some Federal overview of state eligibility determinations to ensure correctness and consistency among states and to use the State-specific error rates as the basis for calculating national eligibility error rates for Medicaid and SCHIP.

The latest form for Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (CMS-10184) expires 2027-11-30 and is listed under ICR 202408-0938-027.

View the official OMB control history on Reginfo.gov.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form CMS-10184 Monthly Sample Selection List	Form and Instruction
Form CMS-10184 Summary of Eligibility and Payment Review Findings	Form and Instruction
Form CMS-10184 Detailed Payment Review Findings	Form
Form CMS-10184 Reporting Individual Payment Findings	Form
Form CMS-10184 Review Findings	Form
Form CMS-10184 Detailed Active Case Review Findings	Form
Form CMS-10184 Reporting Individual Review Findings	Form
Form CMS-10184 Monthly Sample Selection List	Form
Form CMS-10184 Monthly Sampling Lists	Form
Form CMS-10184 MEQC substitution Summary of Findings	Form and Instruction
Form CMS-10184 Reinstatement of Prior Burden Estimates for CMS-10184E	Form and Instruction
Form CMS-10184 MEQC substitution Detailed Case Review Findings	Form
Form CMS-10184 MEQC Substitution	Form and Instruction
Form CMS-10184 Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (MEQC Substitution)	Form and Instruction
CMS - 10184 - Supporting Statement - Part A - Eligibility_PERM 080224.docx	Supporting Statement A
CMS - 10184 - Supporting Statement - Part B - Eligibility.docx	Supporting Statement B
Corrective Action Report	Information collection
Summary of Eligibility and Payment Review Findings	Form and Instruction
Summary of Eligibility and Payment Review Findings	Form and Instruction
Reporting Individual Payment Findings	Form
Reporting Individual Payment Findings	Form
Reporting Individual Review Findings	Form
Reporting Individual Review Findings	Form
Reporting Individual Review Findings	Form
Communications and Review Support	Information collection
Monthly Sampling Lists	Form
Monthly Sampling Lists	Form
Pre-cycle Report	Information collection
Reinstatement of Prior Burden Estimates for CMS-10184E	Form and Instruction
Reinstatement of Prior Burden Estimates for CMS-10184E	Form and Instruction
Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (MEQC Substitution)	Form
Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (MEQC Substitution)	Form and Instruction
Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (MEQC Substitution)	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
202408-0938-027	Reinstatement with change of a previously approved collection	2024-08-28
202405-0938-026	Reinstatement with change of a previously approved collection	2024-05-28	Comment filed on proposed rule
201609-0938-031	Extension without change of a currently approved collection	2016-10-03	Approved without change
201310-0938-003	Reinstatement with change of a previously approved collection	2013-10-25	Approved with change
201007-0938-002	Revision of a currently approved collection	2010-07-13	Approved without change
201002-0938-008	Extension without change of a currently approved collection	2010-02-26	Approved without change
200908-0938-004	Revision of a currently approved collection	2009-08-12	Approved without change
200810-0938-006	No material or nonsubstantive change to a currently approved collection	2008-10-06	Approved without change
200711-0938-004	No material or nonsubstantive change to a currently approved collection	2007-11-15	Approved without change
200611-0938-008	New collection (Request for a new OMB Control Number)	2006-11-22	Approved with change

OMB Details

Pre-cycle Report

Federal Enterprise Architecture: Health - Health Care Services