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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
#13: Medicaid Accountability – Nursing Facility, Outpatient Hospital and Inpatient Hospital Upper Payment Limits
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
CMS-10398 (#13)
Inpatient Hospital UPL Guidance
Inpatient Hospital UPL Guidance final.docx
Yes
Yes
Fillable Printable
Instruction
IP_instructions_final_REVISED.docx
No
Printable Only
Instruction
NF instructions final.docx
No
Printable Only
Form
CMS-10398 (#13)
Nursing Facility UPL Guidance
Nursing Facility UPL Guidance final.docx
Yes
Yes
Fillable Printable
Instruction
OP_instructions final.docx
No
Printable Only
Form
CMS-10398 (#13)
Outpatient Hospital UPL Guidance
Outpatient Hospital UPL Guidance final.docx
Yes
Yes
Fillable Printable
Instruction
SMD_accountability_letter_CMS revised 2-1-13.docx
No
Printable Only
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:
56
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
Requested
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
56
0
56
0
0
0
Annual IC Time Burden (Hours)
2,240
0
2,240
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
#13 Medicaid Accountability – Nursing Facility, Outpatient Hospital and Inpatient Hospital Upper Payment Limits
#13 Medicaid Accountability Upper Payment Limits Supporting Statement {Dec 2014].docx
12/22/2014
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.