Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Sampling Plan Modified 34 34000 0 Instruction
Form CMS-10184 Monthly Sample Selection List
Monthly Sampling Lists Modified 408 40800 0 Form CMS-10184 Monthly Sample Selection List
Review Findings Modified 34 324870 0 Form CMS-10184 Monthly Sample Selection List
Reporting Individual Review Findings Modified 408 40800 0 Form CMS-10184 Detailed Active Case Review Findings
Form CMS-10184 Review Findings
Reporting Individual Payment Findings Modified 408 40800 0 Form CMS-10184 Detailed Payment Review Findings
Summary of Eligibility and Payment Review Findings Modified 34 3400 0 Form and Instruction CMS-10184 Monthly Sample Selection List
Corrective Action Report Modified 34 34000 0 Form CMS-10184 Summary of Eligibility and Payment Review Findings
Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (MEQC Substitution) Modified 19 407094 0 Form and Instruction CMS-10184 MEQC Substitution
Form CMS-10184 MEQC substitution Detailed Case Review Findings
Reinstatement of Prior Burden Estimates for CMS-10184E Modified 204 20400 0 Form and Instruction CMS-10184 MEQC substitution Summary of Findings
Total burden requested under this ICR: 1583 946164 0  
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