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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
GenIC #64 (New): Federal Meta-Analysis Support: Section 1115 Substance Use Disorder Demonstrations
Agency IC Tracking Number:
CMCS
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Introductory Email: Demonstration Characteristics Interview
64 - Attachment 1.a. Demo Characteristics Admin Intro Email from CMS to SMD_clean.docx
Yes
No
Printable Only
Other-Confirmation Email: Demonstration Characteristics Interview
64 - Attachment 1.d. Demo Characteristics Interview Confirmation Email_clean.docx
Yes
No
Printable Only
Other-Outlook Invitation: Demonstration Characteristics Interview
64 - Attachment 1.e. Demo Characteristics Interview Outlook Invitation_clean.docx
Yes
No
Printable Only
Other- Reminder Email: Demonstration Characteristics Interview
64 - Attachment 1.f. Demonstration Characteristics Interview Reminder Email_clean.docx
Yes
Yes
Printable Only
Other-Introductory Email: Implementation Interview
64 - Attachment 2.a. Email CMS to State Administrator Intro RTI Evaluation_clean.docx
Yes
No
Printable Only
Other- Email Invitation: Implementation Interview
64 - Attachment 2.b. Implementation Interview Email Invitation_clean.docx
Yes
No
Printable Only
Other-Confirmation Email: Implementation Interview
64 - Attachment 2.c. Implementation Interview Confirmation Email_clean.docx
Yes
No
Printable Only
Other-Implementation Interview
64 - Attachment 2.d. Implementation Interview Outlook Invitation_clean.docx
Yes
No
Printable Only
Other- Reminder Email: Implementation Interview
64 - Attachment 2.e. Implementation Interview Reminder Email_clean.docx
Yes
No
Printable Only
Form and Instruction
CMS-10398 #64
Demonstration Characteristics Interview Email Invitation and Grid
Attachment 1.b. Demonstration Characteristics Interview Email Invitation_clean_ 5June 2020.docx
Yes
Yes
Fillable Fileable
Form and Instruction
CMS-10398 #64
Demonstration Characteristics Interview Questions
Attachment 1.c. Demonstration Characteristics Interview Questions_clean_5 June 2020.docx
Yes
Yes
Fillable Fileable
Form and Instruction
CMS-10398 #64
Implementation Interview Protocol with Instructions for Interviewer
Attachment 2.f. Implementation Interview Protocol with Instructions for Interviewer_clean_5 June 2020.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:
27
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
54
0
54
0
0
0
Annual IC Time Burden (Hours)
162
0
162
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Generic Supporting Statement
64 - Generic Supporting Statement (2020 version 4).docx
06/05/2020
Supporting Statement B
64 - Supporting Statement Part B_clean_5 June 2020.docx
06/05/2020
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.