Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Payment Error Rate Measurement - State Medicaid and CHIP Eligibility Modified 34 34000 0 Form CMS-10184 CMS-10184.FINAL-PERM Eligibility Error Rate Forms
Instruction
Payment Error Rate Measurement - State Medicaid and CHIP Eligibility Modified 408 40800 0 Form CMS-10184 CMS-10184.FINAL-PERM Eligibility Error Rate Forms
Instruction
Payment Error Rate Measurement - State Medicaid and CHIP Eligibility Modified 34 341870 0 Instruction
Form CMS-10184 CMS-10184.FINAL-PERM Eligibility Error Rate Forms
Payment Error Rate Measurement - State Medicaid and CHIP Eligibility Modified 408 40800 0 Instruction
Form CMS-10184 CMS-10184.FINAL-PERM Eligibility Error Rate Forms
Payment Error Rate Measurement - State Medicaid and CHIP Eligibility Modified 408 40800 0 Instruction
Form and Instruction CMS-10184 CMS-10184.FINAL-PERM Eligibility Error Rate Forms
Payment Error Rate Measurement - State Medicaid and CHIP Eligibility Modified 34 34000 0 Instruction
Form CMS-10184 CMS-10184.FINAL-PERM Eligibility Error Rate Forms
Payment Error Rate Measurement - State Medicaid and CHIP Eligibility Modified 34 3400 0 Instruction
Form CMS-10184 CMS-10184.FINAL-PERM Eligibility Error Rate Forms
Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (MEQC Substitution) Modified 19 407094 0 Form and Instruction CMS-10184D Detailed Payment Review Findings
Form and Instruction CMS-10184A Cases Selected for Review: Monthly Sample Selection List
Form and Instruction CMS-10184B Detailed Active Case Review Findings
Form and Instruction CMS-10184E Summary Findings
Reinstatement of Prior Burden Estimates for CMS-10184E New 204 20400 0 Form CMS-10184.FINAL-PERM_Eligibility_Error_Rate_Forms CMS-10184.FINAL-PERM_Eligibility_Error_Rate_Forms
Instruction
Total burden requested under this ICR: 1583 963164 0  
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