View Information Collection (IC)

View Information Collection (IC)

GenIC #26 (Extension) - Medicaid Adult and Child Core Set Measures
 
New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-PRA Disclosure Statement PRA Disclosure Statement 082919 (rev 08-30-2019).pdf No   Printable Only
Form and Instruction 390-CQM 2018-CCW-CH-PRA-D Contraceptive Care – All Women Ages 15-20 (CCW-CH) CQM2018 QSSI-CCW-CH.pdf Yes Yes Fillable Fileable
Form and Instruction 385-CQM 2018-ADD-CH-PRA-D CQM 2018 - Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication (ADD-CH) Core Measure PRA Document #26 CQM2018.pdf Yes Yes Fillable Fileable
Form and Instruction 385-CQM 2018-ADD-CH-PRA-D CQM 2018 - Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication (ADD-CH) Core Measure PRA Document #26 CQM2017.pdf Yes Yes Fillable Fileable
Form and Instruction 429-AQM 2018 ABA-AD PRA-D AQM 2018 – Adult Body Mass Index Assessment (ABA) Core Measure PRA document AQM2017.pdf Yes Yes Fillable Fileable
Form and Instruction 245-QSSI-MACPro-PRA-AdditionalNotes-D AQM, CQM & MIH - Additional Notes PRA document #26 Common Questions.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

56 0
   
State, Local, and Tribal Governments
 
   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 224 0 224 0 0 0
Annual IC Time Burden (Hours) 8,960 0 8,960 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
GenIC Supporting Statement 26 - Supporting Statement (2019 version 2).docx 08/30/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.