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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Bundle: GenICs 37 (Managed Care Rate Setting Guidance), 50 (Community First Choice State Plan), and 51 (Fast Track for Section 1115 Medicaid and CHIP Demonstration Extensions)
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
Instruction
Medicaid Rate Guide Effective 1.1.17 to 6.30.17 - 10.18.2016.docx
Yes
Yes
Printable Only
Form
CMS-10398 #50
Community First Choice (CFC) State Plan Option Preprint
#50 - Community First Choice template.8.31.16.docx
Yes
Yes
Fillable Fileable
Instruction
#50 - CFC Technical Guide [rev 09-13-2016 by OSORA PRA].docx
Yes
No
Printable Only
Form and Instruction
CMS-10398 #51
#51 - Section 1115 Demonstration FAST TRACK Extension Template for Program Changes
#51 - Extension with Changes Template_09-13-2016.doc
Yes
Yes
Fillable Printable
Form and Instruction
CMS-10398 #51
#51 - 1115(a) Extension State Certification
#51 - 1115a extension state certification 09-13-2016.docx
Yes
Yes
Fillable Fileable
Form and Instruction
CMS-10398 #51
#51 - 1115(e) Extension State Certification
#51 - 1115e extension state certification_09-13-2016.docx
Yes
Yes
Fillable Fileable
Form and Instruction
CMS-10398 #51
#51 - 1115(f) Extension State Certification
#51 - 1115f extension state certification_09-13-2016.docx
Yes
Yes
Fillable Fileable
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:
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
113
0
113
0
0
0
Annual IC Time Burden (Hours)
1,158
0
1,158
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
#37 Supporting Stattement: Managed Care Rate Setting Guidance
#37 Supporting Statement [rev 09-13-2016 by OSORA PRA].docx
09/13/2016
#37 Crosswalk: Managed Care Rate Setting Guidance
#37 - Crosswalk 2016 and 2017 Rate Guide.xlsx
09/13/2016
#50 Supporting Statement: Community First Choice State Plan
GenIC #50 - Supporting Statement [rev 09-13-2016 by OSORA PRA].docx
09/13/2016
#51 Supporting Statement: Fast Track Federal Review Process for Section 1115 Medicaid and CHIP Demonstration Extensions
GenIC #51 - Supporting Statement rev 09-13-2016 OSORA PRA_SDG edits 9 13 16 -- CLEAN.docx
09/13/2016
Bundled Burden Table
Bundled Burden Table (09-13-2016).xlsx
09/13/2016
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.