OMB control number

CHIPRA_ Children Health Insurance

OMB 0990-0384 · HHS/HHSDM.

OMB 0990-0384

Latest Forms, Documents, and Supporting Material

Document Name
Supplemental Information for OMB Review of CHIPRA ICR.docx Supplementary Document
CHIPRA-10 State Selection_ for OMB.pdf Supplementary Document
CHIPRA-10 Sample Design Memo_for OMB.pdf Supplementary Document
0990-CHIP OMB Supporting Statement Part B_10_19_REV.docx Supporting Statement B
0990-CHIP Part A_Attachment G_CHIP Work Group Members.pdf Supplementary Document
0990-CHIP Part A_Attachment K_Site Visit Consent Procedure.pdf Supplementary Document
0990-CHIP Part A_Attachment_Authorizing Legislation.pdf Supplementary Document
0990-CHIP Part A_Attachment J__Contractor Confidentiality Pledge.pdf Supplementary Document
0990-CHIP Part B_Attachment A_Evaluation Design Report.pdf Supplementary Document
0990-CHIP Part B_Attachment I1_Focus Group Consent Form for Parents of CHIP Enrollees.pdf Supplementary Document
0990-CHIP Part B_Attachment I2_Focus Group Consent Form for Parents of CHIP Disenrollees.pdf Supplementary Document
0990-CHIP Part B_Attachment I3_Focus Group Consent Form for Parents of Eligible but Uninsured.pdf Supplementary Document
0990-CHIP Part A_Attachment I4_Focus Group Consent Form for Parents of Children Covered by Employer-Sponsored Insurance.pdf Supplementary Document
0990-CHIP Part B_Attachment C_Pretest Report.pdf Supplementary Document
0990-CHIP Part B_Attachment D__Respondent Materials.pdf Supplementary Document
0990-CHIP OMB Supporting Statement Part A_ver4.docx Supporting Statement A
Parents and other family members of Children (focus group) Other-focus group guide
CHIP and Medicaid Personnel Other-discussion guide
Medicaid Enrollees and Disenrolles Other-survey
CHIP/Medicaid Enrollees and Disenrollees Other-survey

All Historical Document Collections

201110-0990-006 Approved with change	New collection (Request for a new OMB Control Number)	2011-10-27
201109-0990-002 Improperly submitted	New collection (Request for a new OMB Control Number)	2011-09-29