Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
GenIC #26 (Revision): Child and Adult Core Set Measures New 357 1066 0 Form and Instruction AQM-01
Form and Instruction AQM-02
Form and Instruction AQM-03
Form and Instruction AQM-04
Form and Instruction AQM-05
Form and Instruction AQM-06
Form and Instruction AQM-07
Form and Instruction AQM-08
Form and Instruction AQM-09
Form and Instruction AQM-10
Form and Instruction AQM-11
Form and Instruction AQM-12
Form and Instruction AQM-13 PQI 01
Form and Instruction AQM-14 PQI 05
Form and Instruction AQM-15 PQI 15
Form and Instruction AQM-16 PQI 08
Form and Instruction AQM-17
Form and Instruction AQM-18
Form and Instruction AQM-19
Form and Instruction AQM-20
Form and Instruction AQM-21
Form and Instruction AQM-22
Form and Instruction AQM-23
Form and Instruction AQM-24
Form and Instruction AQM-25
Form and Instruction AQM-26
Form and Instruction AQM-27
Form and Instruction AQM-28
Form and Instruction AQM-29
Form and Instruction AQM-30
Form and Instruction AQM-31
Form and Instruction AQM-32
Form and Instruction AQM-33
Form and Instruction AQM-34
Form and Instruction AQM-35
Form and Instruction AQM-36
Form and Instruction AQM-37
Form and Instruction AQM-38
Form and Instruction AQM-39
Form AQM-40
Form and Instruction CQM-01
Form and Instruction CQM-02
Form and Instruction CQM-03
Form and Instruction CQM-04
Form and Instruction CQM-05
Form and Instruction CQM-06
Form and Instruction CQM-07
Form and Instruction CQM-08
Form and Instruction CQM-09
Form and Instruction CQM-10
Form and Instruction CQM-11
Form and Instruction CQM-12
Form and Instruction CQM-13
Form and Instruction CQM-14
Form and Instruction CQM-15
Form and Instruction CQM-16
Form and Instruction CQM-17
Form and Instruction CQM-18
Form and Instruction CQM-19
Form and Instruction CQM-20
Form and Instruction CQM-21
Form and Instruction CQM-22
Form and Instruction CQM-23
Form and Instruction CQM-25
Form and Instruction CQM-26
Form and Instruction CQM-27
Form and Instruction CQM-28
Form and Instruction CQM-29
Form and Instruction CQM-30
Form and Instruction SQM-01
Form and Instruction CQM-24
GenIC #47 (Revised):Health Home Core Sets New 1 5 0 Form and Instruction HHQM-01
Form and Instruction HHQM-02
Form and Instruction HHQM-03
Form and Instruction HHQM-04
Form and Instruction HHQM-05
Form and Instruction HHQM-06
Form and Instruction HHQM-07
Form and Instruction HHQM-08
Form and Instruction HHQM-09
Form and Instruction HHQM-11
Form and Instruction HHQM-14
Form and Instruction HHQM-15
Form and Instruction HHQM-15
Form and Instruction HHQM-13
GenIC #66 (Revision): Eligibility Processing Data Report and Renewal Compliance Template New 1400 21056 0 Form and Instruction CMS-10398 #66
Other-Eligibility Processing Data Report Specifications
Form CMS-10398 #66
Form CMS-10398 #66
Other-SHO Letter 24-002
GenIC #66 (Revision): Medicaid and Children's Health Insurance Program Eligibility Processing Data Report New 1344 18816 0 Form CMS-10398 #66
Instruction
Form CMS-10398 #66
Other-SHO Letter
Used Burden (GenIC Inventory) New 696 20712 0 Other-GenIC Inventory
[Medicaid] GenIC #26 (Nonsubstantive Change): Child and Adult Core Set Measures New 1 5 0
[Medicaid] GenIC #26 (Revised): Child and Adult Core Set Measures New 61098 98911 0 Form and Instruction AQM-01
Form and Instruction AQM-02
Form and Instruction AQM-03
Form and Instruction QM-04
Form and Instruction AQM-05
Form and Instruction AQM-06
Form and Instruction AQM-07
Form and Instruction AQM-08
Form and Instruction AQM-09
Form and Instruction AQM-10
Form and Instruction AQM-11
Form and Instruction AQM-12
Form and Instruction AQM-14, PQI 05
Form and Instruction AQM-13, PQI 01
Form and Instruction AQM-14, PQI 05
Form and Instruction AQM-15, PQI 15
Form and Instruction AQM-16, PQI 08
Form and Instruction AQM-17
Form and Instruction AQM-18
Form and Instruction AQM-19
Form and Instruction AQM-20
Form and Instruction AQM-21
Form and Instruction AQM-22
Form and Instruction AQM-23
Form and Instruction AQM-24
Form and Instruction AQM-25
Form and Instruction AQM-26
Form and Instruction AQM-27
Form and Instruction AQM-28
Form and Instruction AQM-29
Form and Instruction AQM-30
Form and Instruction AQM-31
Form and Instruction AQM-32
Form and Instruction AQM-33
Form and Instruction AQM-34
Form and Instruction CQM-01
Form and Instruction CQM-02
Form and Instruction CQM-03
Form and Instruction CQM-04
Form and Instruction CQM-05
Form and Instruction CQM-06
Form and Instruction CQM-07
Form and Instruction CQM-08
Form and Instruction CQM-09
Form and Instruction CQM-10
Form and Instruction CQM-11
Form and Instruction CQM-12
Form and Instruction CQM-13
Form and Instruction CQM-14
Form and Instruction CQM-15
Form and Instruction CQM-16
Form and Instruction CQM-17
Form and Instruction CQM-18
Form and Instruction CQM-19
Form and Instruction CQM-20
Form and Instruction CQM-21
Form and Instruction CQM-22
Form and Instruction CQM-23
Form and Instruction CQM-24
Form and Instruction CQM-25
Form and Instruction CQM-26
Form and Instruction CQM-27
Form and Instruction CQM-28
Form CMS-10434 #26
Other-SPA Implementation Guide
[Medicaid] GenIC #47 (Revised): Health Home Core Sets New 104 5754 0 Form and Instruction HHQM - 01
Form and Instruction HHQM - 02
Form and Instruction HHQM - 03
Form and Instruction HHQM - 04
Form and Instruction HHQM-05
Form and Instruction HHQM - 06
Form and Instruction HHQM - 07
Form and Instruction HHQM - 08
Form and Instruction HHQM - 09
Form and Instruction HHQM - 10
Form and Instruction HHQM - 11
Form and Instruction HHQM - 12
Form and Instruction HHQM - 13
Form and Instruction HHQM - 14
[Medicaid] GenIC #47 (non-Substantive Change): Health Home Core Sets New 1 5 0
[Medicaid] GenIC #82 (New): Quality Improvement Affinity Group Expression of Interest Form New 20 60 0 Form and Instruction GenIC #82
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 65022 166390 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
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