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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
GenIC #45 (Extension w/o change): Maternal and Infant Health Quality
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
Form
CMS-10398 #45
Maternal and Infant Health (MIH) Quality Screenshot #1 (Women)
MIH_2015_by Women_1.pdf
Yes
Yes
Fillable Fileable
Form
CMS-10398 #45
Maternal and Infant Health (MIH) Quality Screenshot #2 (Women)
MIH_2015_by Women_2.pdf
Yes
Yes
Fillable Fileable
Form
CMS-10398 #45
Maternal and Infant Health (MIH) Quality Screenshot #3 (Women)
MIH_2015_by Women_3.pdf
Yes
Yes
Fillable Fileable
Form
CMS-10398 #45
Maternal and Infant Health (MIH) Quality Screenshot #4 (Women)
MIH_2015_by Women_4.pdf
Yes
Yes
Fillable Fileable
Form
CMS-10398 #45
Maternal and Infant Health (MIH) Quality Screenshot #5 (Women)
MIH_2015_by Women_5.pdf
Yes
Yes
Fillable Fileable
Form
CMS-10398 #45
Maternal and Infant Health (MIH) Quality Screenshot #6 (Women)
MIH_2015_by Women_6.pdf
Yes
Yes
Fillable Fileable
Form
CMS-10398 #45
Maternal and Infant Health (MIH) Quality Screenshot #1 (Postpartum Women)
MIH_2015_Postpartum Women_1.pdf
Yes
Yes
Fillable Fileable
Form
CMS-10398 #45
Maternal and Infant Health (MIH) Quality Screenshot #2 (Postpartum Women)
MIH_2015_Postpartum Women_2.pdf
Yes
Yes
Fillable Fileable
Form
CMS-10398 #45
Maternal and Infant Health (MIH) Quality Screenshot #3 (Postpartum Women)
MIH_2015_Postpartum Women_3.pdf
Yes
Yes
Fillable Fileable
Form
CMS-10398 #45
Maternal and Infant Health (MIH) Quality Screenshot #4 (Postpartum Women)
MIH_2015_Postpartum Women_4.pdf
Yes
Yes
Fillable Fileable
Form
CMS-10398 #45
Maternal and Infant Health (MIH) Quality Screenshot #5 (Postpartum Women)
MIH_2015_Postpartum Women_5.pdf
Yes
Yes
Fillable Fileable
Form
CMS-10398 #45
Maternal and Infant Health (MIH) Quality Screenshot #6 (Postpartum Women)
MIH_2015_Postpartum Women_6.pdf
Yes
Yes
Fillable Fileable
Form
CMS-10398 #45
Maternal and Infant Health (MIH) Quality Screenshot #7 (Postpartum Women)
MIH_2015_Postpartum Women_7.pdf
Yes
Yes
Fillable Fileable
Form
CMS-10398 #45
Maternal and Infant Health (MIH) Quality Screenshot #8 (Postpartum Women)
MIH_2015_Postpartum Women_8.pdf
Yes
Yes
Fillable Fileable
Form
CMS-10398 #45
Maternal and Infant Health (MIH) Quality Screenshot #9 (Postpartum Women)
MIH_2015_Postpartum Women_9.pdf
Yes
Yes
Fillable Fileable
Form
CMS-10398 #45
Maternal and Infant Health (MIH) Quality Screenshot #10 (Postpartum Women)
MIH_2015_Postpartum Women_10.pdf
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:
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
112
0
112
0
0
0
Annual IC Time Burden (Hours)
112
0
112
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
#45 - Supporting Statement
45 - Supporting Statement MIH Quality.docx
01/12/2018
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.