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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Bundle: (GenIC 1) Medicaid Buy In, (GenIC 2) CNIPRA Cycle II, and (GenIC 3) PIE Transaction
Agency IC Tracking Number:
IC Status:
New
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
CMS-10398-007
CHIPRA Cycle II - Outreach and Enrollment Grant Semi-Annual Report Template
CHIPRA Cycle II Semi-Annual Template_Final Draft for PRA [rev 04-11-2012 OSORA].doc
Yes
Yes
Fillable Printable
Form and Instruction
CMS-10398-006
Medicaid Buy-In Program: 2010 Policy Update
Medicaid Buy In Program [rev 04-11-2012 OSORA].docx
Yes
Yes
Fillable Printable
Instruction
PIE - Attachment B Companion Guide - Business Scenarios (2).pdf
Yes
No
Fillable Printable
Instruction
PIE - Attachment C SMD10011 (2).pdf
Yes
No
Fillable Printable
Form and Instruction
CMS-10398-008
Payer Initiated Eligibility/Benefit (PIE) Transaction - DRA Companion Guide
PIE - Attachment A PIE Transaction Companion Guide- June 2010 (2).pdf
Yes
Yes
Fillable Printable
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:
130
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
169
0
0
0
0
0
Annual IC Time Burden (Hours)
3,380
0
0
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Medicaid Buy-In - Supporting Statement
Medicaid Buy In Supporting Statement.docx
04/11/2012
CHIPRA Cycle II Semi-Annual Report Template - Supporting Statement
CHIPRA Cycle II - Semi Annual Report Supporting Statement March 2012.docx
04/11/2012
PIE Transaction - Supporting Statement
PIE Supporting Statement.docx
04/11/2012
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.