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ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
[Medicaid] GenIC #64 (Revision) Medicaid Section 1115 Substance Use Disorder (SUD) Demonstrations: Federal Meta Analysis
Agency IC Tracking Number:
CMCS
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
1a
Characteristics/Implementation Introductory Email
Attachment1aDemonstrationCharacteristicsandImplementationAdministratorIntroEmail.docx
Yes
Yes
Fillable Fileable
Form
1b
Characteristics/Implementation Interview Email Invitation with Program Characteristics Grid
Attachment1bDemonstrationCharacteristicsandImplementationInterviewEmailInvitation.docx
Yes
Yes
Fillable Fileable
Form and Instruction
1c
Interview Questions
Attachment1cDemonstrationCharacteristicsandImplementationInterviewQuestions.docx
No
Printable Only
Form
1d
Characteristics/Implementation Confirmation Email
Attachment1dDemonstrationCharacteristicsandImplementationInterviewConfirmationEmail.docx
Yes
Yes
Fillable Fileable
Form
1e
Characteristics/Implementation Interview Invitation
Attachment1eDemonstrationCharacteristicsandImplementationInterviewOutlookInvitation.docx
Yes
Yes
Fillable Fileable
Form
1f
Characteristics/Implementation Interview Reminder Email
Attachment1fDemonstrationCharacteristicsandImplementationInterviewReminderEmail.docx
Yes
Yes
Fillable Fileable
Form
1g
Characteristics/Implementation Interview Thank You Email
Attachment1gDemonstrationCharacteristicsandImplementationInterviewThankYouEmail.docx
Yes
Yes
Fillable Fileable
Form
3a
MCO and Behavioral Health Stakeholder Interview Introductory Email
Attachment3aMCO-BHStakeholderInterviewIntroductoryEmailtoSMDfromCMS.docx
Yes
Yes
Fillable Fileable
Form
3b
MCO and Behavioral Health Provider Stakeholder Interview Introductory Email
Attachment3bMCO-BHStakeholderInterviewIntroductoryEmailtoSMDfromRTI.docx
Yes
Yes
Fillable Fileable
Form
3c
MCO and Behavioral Health Provider Stakeholder Interview Introductory Email
Attachment3cMCO-BHStakeholderInterviewIntroductoryEmailfromSMD.docx
Yes
Yes
Fillable Fileable
Form
3d
MCO and Behavioral Health Provider Stakeholder Interview Email Invitation
Attachment3dMCO-BHStakeholderInterviewEmailInvitation.docx
Yes
Yes
Fillable Fileable
Form
3e
MCO and Behavioral Health Provider Stakeholder Interview Outlook Invitation
Attachment3eMCO-BHStakeholderInterviewOutlookInvitation.docx
Yes
Yes
Fillable Fileable
Form
3f
MCO and Behavioral Health Provider Stakeholder Interview Confirmation Email
Attachment3fMCO-BHStakeholderInterviewConfirmationEmail.docx
Yes
Yes
Fillable Fileable
Form and Instruction
3g
MCO Protocol with Instructions
Attachment3gMCOProtocolwithInstructions.docx
Yes
Yes
Fillable Fileable
Form and Instruction
3h
Behavioral Health Stakeholder Interview Protocol with Instructions (Residential Providers)
Attachment3hBHStakeholderInterviewProtocolwithInstructions-Residential.docx
Yes
Yes
Fillable Fileable
Form and Instruction
3i
Behavioral Health Stakeholder Interview Protocol with Instructions (Non-Residential Providers)
Attachment3iBHStakeholderInterviewProtocolwithInstructions-Nonresidential.docx
Yes
Yes
Fillable Fileable
Form
3j
MCO and Behavioral Health Provider Stakeholder Interview Thank You Email
Attachment3jMCO-BHStakeholderInterviewThankYouEmail.docx
Yes
Yes
Fillable Fileable
Form
4a
Follow-Up Implementation Interview Introductory Email
Attachment4aFollow-upImplementationInterviewIntroductoryEmailfromCMStoSMD.docx
Yes
Yes
Fillable Fileable
Form
4b
Follow-Up Implementation Interview Email Invitation
Attachment4bFollow-upImplementationInterviewEmailInvitation.docx
Yes
Yes
Fillable Fileable
Form
4c
Follow-Up Implementation Interview Confirmation Email
Attachment4cFollow-upImplementationInterviewConfirmationEmail.docx
Yes
Yes
Fillable Fileable
Form
4d
Follow-Up Implementation Interview Outlook Invitation
Attachment4dFollow-upImplementationInterviewOutlookInvitationText.docx
Yes
Yes
Fillable Fileable
Form
4e
Follow-Up Implementation Interview Reminder Email
Attachment4eFollow-upImplementationInterviewReminderEmail.docx
Yes
Yes
Fillable Fileable
Form and Instruction
4f
Follow-Up Implementation Interview Protocol with Instructions
Attachment4fFollow-upImplementationInterviewProtocol.docx
Yes
Yes
Fillable Fileable
Form
4g
Follow-Up Implementation Interview Thank You Email
Attachment4gFollow-upImplementationInterviewThankYouEmail.docx
Yes
Yes
Fillable Fileable
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:
211
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
384
0
384
0
0
0
Annual IC Time Burden (Hours)
506
0
506
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Generic Supporting Statement
GenIC 64 -Generic-Supporting-Statement (2026 version 14).docx
03/02/2026
Public Comment (Anonymous)
Comment - mfd-c5t8-7w1y.pdf
03/02/2026
Response to Public Comments
Response-to-Public-Comments.pdf
03/02/2026
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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