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 324870 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 3400 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 Form CMS-10184 CMS-10184.FINAL-PERM Eligibility Error Rate Forms
Instruction
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 34000 0 Form and Instruction CMS-10184 PERM Review Summary and Instructions
Instruction
Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (MEQC Substitution) Modified 19 407094 0 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
Form and Instruction CMS-10184 Negative Case Review Findings
Reinstatement of Prior Burden Estimates for CMS-10184E Modified 204 20400 0 Form and Instruction 101814E CMS-10184
Form and Instruction CMS 10184 CMS-10184
Total burden requested under this ICR: 1583 946164 0  
To view an IC, click on IC Title