OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

State Children's Health Insurance Program (SCHIP) Report on Payables and Receivables (CMS-10180)

IC 43677 under ICR 202002-0938-008 · OMB 0938-0988.

Documents and Forms
Document Name
Document Type
Instruction
Instruction
Form
IC Document
Information Collection (IC) Details

View Information Collection (IC)

State Children's Health Insurance Program (SCHIP) Report on Payables and Receivables (CMS-10180) OFM
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction IBNRSUserGuide_v1.7_3-2014 - Copy.pdf No   Fillable Fileable
Form CMS-10180 CHIP INCURRED BUT NOT REPORTED (IBNR) SURVEY CMS-10180 Form_508_10-22-19.pdf Yes Yes Fillable Fileable
Instruction CMS-10180 Validation Letter_2020_508.pdf No   Printable Only

Health Health Care Services

 

56 0
   
State, Local, and Tribal Governments
 
   0 %

  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 56 0 0 0 0 56
Annual IC Time Burden (Hours) 1,792 0 0 1,400 0 392
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk CMS-10180 System Crosswalk_508_10-11-19.pdf 02/14/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.