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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
GenIC #64 (Revision): Federal Meta-Analysis Support: Section 1115 Substance Use Disorder Demonstrations
Agency IC Tracking Number:
CMCS
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
Other-Demonstration Characteristics Interview Introductory Email
64 - Attachment 1.a. Demo Characteristics Admin Intro Email from CMS to SMD_clean.docx
Yes
Yes
Printable Only
Other-Demonstration Characteristics Interview Email Invitation with Program Characteristics Grid
Attachment 1.b. Demonstration Characteristics Interview Email Invitation_clean_ 5June 2020.docx
Yes
Yes
Fillable Fileable
Instruction
Attachment 1.c. Demonstration Characteristics Interview Questions_clean_5 June 2020.docx
No
Printable Only
Other-Demonstration Characteristics Interview Confirmation Email
64 - Attachment 1.d. Demo Characteristics Interview Confirmation Email_clean.docx
Yes
No
Printable Only
Other-Demonstration Characteristics Interview Outlook Invitation
64 - Attachment 1.e. Demo Characteristics Interview Outlook Invitation_clean.docx
Yes
No
Printable Only
Other-Demonstration Characteristics Interview Reminder Email
64 - Attachment 1.f. Demonstration Characteristics Interview Reminder Email_clean.docx
Yes
No
Printable Only
Other-Implementation Interview Introductory Email from CMS to State Medicaid Director and Single State Substance Abuse Agency Director
64 - Attachment 2.a. Email CMS to State Administrator Intro RTI Evaluation_clean.docx
Yes
No
Printable Only
Other-Implementation Interview Email Invitation
64 - Attachment 2.b. Implementation Interview Email Invitation_clean.docx
Yes
No
Printable Only
Other-Implementation Interview Confirmation Email
64 - Attachment 2.c. Implementation Interview Confirmation Email_clean.docx
Yes
No
Printable Only
Other-Implementation Interview Outlook Invitation
64 - Attachment 2.d. Implementation Interview Outlook Invitation_clean.docx
Yes
No
Printable Only
Other-Implementation Interview Reminder Email
64 - Attachment 2.e. Implementation Interview Reminder Email_clean.docx
Yes
No
Printable Only
Instruction
Attachment 2.f. Implementation Interview Protocol with Instructions for Interviewer_clean_5 June 2020.docx
No
Printable Only
Other-MCO and Behavioral Health Stakeholder Interview Introductory Email from CMS to State Medicaid Director
Attachment 3.a. MCO-BH Administrator Interview Introductory Email to SMD from CMS.pdf
Yes
No
Printable Only
Other-MCO and Behavioral Health Provider Stakeholder Interview Introductory Email from RTI to State Medicaid Director
Attachment 3.b. MCO-BH Administrator Interview Introductory Email to SMD from RTI_DDME.pdf
Yes
No
Printable Only
Other-MCO and Behavioral Health Provider Stakeholder Interview Introductory Email from State Medicaid Director
Attachment 3.c. MCO.BH Administrator Introductory Email from SMD.pdf
Yes
No
Printable Only
Other-MCO and Behavioral Health Provider Stakeholder Interview Email Invitation
Attachment 3.d. MCO-BH Administrator Interview Introductory Email.pdf
Yes
No
Printable Only
Other-MCO and Behavioral Health Provider Stakeholder Interview Outlook Invitation
Attachment 3.e. MCO.BH Administrator Interview Outlook Invitation_clean.pdf
Yes
No
Printable Only
Other-MCO and Behavioral Health Provider Stakeholder Interview Confirmation Email
Attachment 3.f. MCO.BH Administrator Interview Confirmation Email_clean.pdf
Yes
No
Printable Only
Instruction
Attachment 3.g. OMB.MCO_interview_protocol_CMSComments_RTI_CLEAN2_12.14.21.pdf
No
Printable Only
Instruction
Attachment 3.h. OMB.BH_interview_residential_protocol_CMSComments_RTI_clean_12.14.21.pdf
No
Printable Only
Instruction
Attachment 3.i. OMB.BH_interview_NONresidential_protocol_CMSComments_RTI_clean_12.14.21.pdf
No
Printable Only
Other-MCO and Behavioral Health Provider Stakeholder Interview Thank You Email
Attachment 3.j. MCO.BH Administrator.Thank you note .pdf
Yes
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:
60
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
340
0
340
0
0
0
Annual IC Time Burden (Hours)
405
0
405
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 (2023 version 8).docx
07/06/2023
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.