Information Collection

Interviews with State Medicaid Managers

IC 229955 under ICR 201712-0920-010 · OMB 0920-1224.

Documents and Forms

Document Name Document Type
Interviews with State Medicaid Managers Form and Instruction
Interview Guide Att 3. Interview Guide 2017-09-15_clean.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Interviews with State Medicaid Managers	Agency IC Tracking Number:

Is this a Common Form? No		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 and Instruction	n/a	Interview Guide	Att 3. Interview Guide 2017-09-15_clean.docx		No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6	6
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	394	394

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.