Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (CMS-10184)

ICR 202405-0938-026

OMB: 0938-1012

Federal Form Document

Forms and Documents

Document Name	Status
Form CMS-10184 Summary of Eligibility and Payment Review Findings Form and Instruction	Removed
Form CMS-10184 Reporting Individual Payment Findings Form	Removed
Form CMS-10184 Reporting Individual Review Findings Form	Removed
Form CMS-10184 Monthly Sampling Lists Form	Removed
Form CMS-10184 Reinstatement of Prior Burden Estimates for CMS-10184E Form and Instruction	Removed
Form CMS-10184 Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (MEQC Substitution) Form and Instruction	Removed
CMS - 10184 - Supporting Statement - Part B - Eligibility.docx Supporting Statement B	2024-05-24
CMS - 10184 - Supporting Statement - Part A - Eligibility_PERM 5-22-24.docx Supporting Statement A	2024-05-24

IC Document Collections

IC ID	Document Title	Status
46149	Corrective Action Report	Modified
46148	Summary of Eligibility and Payment Review Findings Form and Instruction	Removed
46147	Reporting Individual Payment Findings Form	Removed
46146	Reporting Individual Review Findings Form	Removed
46145	Communications and Review Support	Modified
46144	Monthly Sampling Lists Form	Removed
46143	Pre-cycle Report	Modified
193769	Reinstatement of Prior Burden Estimates for CMS-10184E Form and Instruction	Removed
190303	Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (MEQC Substitution) Form and Instruction	Removed