View Information Collection (IC)

View Information Collection (IC)

IC Title:	#37 (2016 Managed Care Rate Setting Guidance)	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			37 - 2016 Medicaid Rate Guide final 7-16-15_OMBedits.doc		Yes	Yes	Fillable Printable
Other-Crosswalk			37 - Copy of Crosswalk 2016 Rate Guide.xlsx		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: 70	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	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	70	0	70	0	0	0
Annual IC Time Burden (Hours)	140	0	140	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
37 - Supporting Statement 2016 Managed Care Rate Setting Guidance	37 - Supporting Statement 2016 Managed Care Rate Setting Guidance.docx	09/16/2015

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.