OMB control number

Medicaid Emergency Psychiatric Services Demonstration Evaluation

OMB 0938-1225 · HHS/CMS.

OMB 0938-1225

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form CMS-10487 Key Informant Interview Protocols	Form and Instruction
Form CMS-10487 Beneficiary Interview Protocol, Consent Form; and Recruiment Script	Form and Instruction
Form CMS-10487 Medical Record Review Tools	Form and Instruction
Form CMS-10487 Sampling Procedures for Medical Record Review	Form and Instruction
Form CMS-10487 Key Informant Interview Protocols	Form and Instruction
Form CMS-10487 Medical Record Review Tools	Form and Instruction
Form CMS-10487 Sampling Procedures for Medical Record Review	Form and Instruction
Form CMS-10487 Key Informant Interview Protocols	Form and Instruction
Parts_A-B.pdf	Supporting Statement B
Attachment_K.pdf	Supplementary Document
Attachment_I.pdf	Supplementary Document
Attachment_H.pdf	Supplementary Document
Attachment_G.pdf	Supplementary Document
Attachment_F.pdf	Supplementary Document
Crosswalks_508-cert_111813.pdf	Supplementary Document
CMS-10487 Supporting Statement A_rev_clean_022414.docx	Supporting Statement A
Medicaid Emergency Psychiatric Services Demonstration Evaluation - states	Form and Instruction
Medicaid Emergency Psychiatric Services Demonstration Evaluation - IMDs	Form and Instruction
Medicaid Emergency Psychiatric Services Demonstration Evaluation - IMDs	Form and Instruction
Medicaid Emergency Psychiatric Services Demonstration Evaluation - IMDs	Form and Instruction
Medicaid Emergency Psychiatric Services Demonstration Evaluation - IMDs	Form and Instruction
Medicaid Emergency Psychiatric Services Demonstration Evaluation - Facilities	Form and Instruction
Medicaid Emergency Psychiatric Services Demonstration Evaluation - Facilities	Form and Instruction
Medicaid Emergency Psychiatric Services Demonstration Evaluation - Facilities	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Concluded	Action
201312-0938-018	New collection (Request for a new OMB Control Number)	2013-12-23		Approved with change