GenIC #26 (Transfer from 0938-1148) - Medicaid Adult and Child Core Set Measures

Medicaid and CHIP Program (MACPro) (CMS-10434)

OMB: 0938-1188

IC ID: 236825

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GenIC #26 (Transfer from 0938-1148) - Medicaid Adult and Child Core Set Measures CMCS
 
New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10434 #26 AQM2017-ABA QSSI-MACPro-PRA-AQM2017-ABA.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2017-AdminScreen QSSI-MACPro-PRA-AQM2017-AdminScreen.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2017-AMM QSSI-MACPro-PRA-AQM2017-AMM.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2017-BCS QSSI-MACPro-PRA-AQM2017-BCS.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2017-CBP QSSI-MACPro-PRA-AQM2017-CBP.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2017-CCP QSSI-MACPro-PRA-AQM2017-CCP.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2017-CCS QSSI-MACPro-PRA-AQM2017-CCS.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2017-CDF QSSI-MACPro-PRA-AQM2017-CDF.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2017-CHL QSSI-MACPro-PRA-AQM2017-CHL.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2017-CPA QSSI-MACPro-PRA-AQM2017-CPA.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2017-FUA QSSI-MACPro-PRA-AQM2017-FUA.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2017-FUH QSSI-MACPro-PRA-AQM2017-FUH.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2017-FVA QSSI-MACPro-PRA-AQM2017-FVA.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2017-HA1C QSSI-MACPro-PRA-AQM2017-HA1C.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2017-HPC QSSI-MACPro-PRA-AQM2017-HPC.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2017-HPCMI QSSI-MACPro-PRA-AQM2017-HPCMI.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2017-HVL QSSI-MACPro-PRA-AQM2017-HVL.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2017-IET QSSI-MACPro-PRA-AQM2017-IET.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2017-MPM QSSI-MACPro-PRA-AQM2017-MPM.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2017-MSC QSSI-MACPro-PRA-AQM2017-MSC.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2017-OHD QSSI-MACPro-PRA-AQM2017-OHD.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2017-PCO1 QSSI-MACPro-PRA-AQM2017-PC01.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2017-PC03 QSSI-MACPro-PRA-AQM2017-PC03.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2017-PCR QSSI-MACPro-PRA-AQM2017-PCR.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2017-PPC QSSI-MACPro-PRA-AQM2017-PPC.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2017-PQI01 QSSI-MACPro-PRA-AQM2017-PQI01.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2017-PQI05 QSSI-MACPro-PRA-AQM2017-PQI05.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2017-PQI08 QSSI-MACPro-PRA-AQM2017-PQI08.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2017-PQI15 QSSI-MACPro-PRA-AQM2017-PQI15.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2017-SAA QSSI-MACPro-PRA-AQM2017-SAA.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2017-SSD QSSI-MACPro-PRA-AQM2017-SSD.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2018-ABA QSSI-MACPro-PRA-AQM2018-ABA.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2018-AdminScreen QSSI-MACPro-PRA-AQM2018-AdminScreen.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2018-AMM QSSI-MACPro-PRA-AQM2018-AMM.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2018-AMR QSSI-MACPro-PRA-AQM2018-AMR.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2018-HPC QSSI-MACPro-PRA-AQM2018-HPC.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2018-HPCMI QSSI-MACPro-PRA-AQM2018-HPCMI.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2018-HVL QSSI-MACPro-PRA-AQM2018-HVL.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2018-IET QSSI-MACPro-PRA-AQM2018-IET.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2018-MPM AD QSSI-MACPro-PRA-AQM2018-MPM-AD.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2018-MSC QSSI-MACPro-PRA-AQM2018-MSC.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2018-OHD QSSI-MACPro-PRA-AQM2018-OHD.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2018-PC01 AD QSSI-MACPro-PRA-AQM2018-PC01-AD.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2018-PC03 AD QSSI-MACPro-PRA-AQM2018-PC03-AD.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2018-PCR AD QSSI-MACPro-PRA-AQM2018-PCR-AD.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2018-PPC AD QSSI-MACPro-PRA-AQM2018-PPC-AD.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2018-PQI01 QSSI-MACPro-PRA-AQM2018-PQI01.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2018-PQI05 QSSI-MACPro-PRA-AQM2018-PQI05.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2018-BCS QSSI-MACPro-PRA-AQM2018-BCS.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2018-CBP QSSI-MACPro-PRA-AQM2018-CBP.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2018-CCP QSSI-MACPro-PRA-AQM2018-CCP.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2018-CCS QSSI-MACPro-PRA-AQM2018-CCS.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2018-CCW QSSI-MACPro-PRA-AQM2018-CCW.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2018-CHL QSSI-MACPro-PRA-AQM2018-CHL.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2018-COB QSSI-MACPro-PRA-AQM2018-COB.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2018-CPA QSSI-MACPro-PRA-AQM2018-CPA.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2018-FUA FUM QSSI-MACPro-PRA-AQM2018-FUA_FUM.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2018-FUH QSSI-MACPro-PRA-AQM2018-FUH.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2018-FVA QSSI-MACPro-PRA-AQM2018-FVA.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2018-HA1C QSSI-MACPro-PRA-AQM2018-HA1C.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2017-AUD QSSI-MACPro-PRA-CQM2017-AUD.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2017-AWC QSSI-MACPro-PRA-CQM2017-AWC.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2017-BHRA QSSI-MACPro-PRA-CQM2017-BHRA.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2017-CAP QSSI-MACPro-PRA-CQM2017-CAP.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2017-CHL QSSI-MACPro-PRA-CQM2017-CHL.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2017-CIS QSSI-MACPro-PRA-CQM2017-CIS.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2017-CLABSI QSSI-MACPro-PRA-CQM2017-CLABSI.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2017-CPC QSSI-MACPro-PRA-CQM2017-CPC.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2017-DEV QSSI-MACPro-PRA-CQM2017-DEV.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2017-FPC QSSI-MACPro-PRA-CQM2017-FPC.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2017-FUH QSSI-MACPro-PRA-CQM2017-FUH.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2017-IMA QSSI-MACPro-PRA-CQM2017-IMA.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2017-LBW QSSI-MACPro-PRA-CQM2017-LBW.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2017-MMA QSSI-MACPro-PRA-CQM2017-MMA.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2017-PC02 QSSI-MACPro-PRA-CQM2017-PC02.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2017-PDENT QSSI-MACPro-PRA-CQM2017-PDENT.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2017-PPC QSSI-MACPro-PRA-CQM2017-PPC.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2017-SEAL QSSI-MACPro-PRA-CQM2017-SEAL.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2017-SRA QSSI-MACPro-PRA-CQM2017-SRA.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2017-StateSpecific QSSI-MACPro-PRA-CQM2017-StateSpecific.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2017-W15 QSSI-MACPro-PRA-CQM2017-W15.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2017-W34 QSSI-MACPro-PRA-CQM2017-W34.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2017-WCC QSSI-MACPro-PRA-CQM2017-WCC.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2018-ADD-CH QSSI-MACPro-PRA-CQM2018-ADD-CH.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2018-AdminScreen QSSI-MACPro-PRA-CQM2018-AdminScreen.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2018-AMB-CH QSSI-MACPro-PRA-CQM2018-AMB-CH.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2018-AMR-CH QSSI-MACPro-PRA-CQM2018-AMR-CH.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2018-APC-CH QSSI-MACPro-PRA-CQM2018-APC-CH.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2018-APP-CH QSSI-MACPro-PRA-CQM2018-APP-CH.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2018-AUD-CH QSSI-MACPro-PRA-CQM2018-AUD-CH.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2018-AWC-CH QSSI-MACPro-PRA-CQM2018-AWC-CH.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2018-CAP-CH QSSI-MACPro-PRA-CQM2018-CAP-CH.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2018-CCP-CH QSSI-MACPro-PRA-CQM2018-CCP-CH.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2018-CCW-CH QSSI-MACPro-PRA-CQM2018-CCW-CH.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2018-CDF-CH QSSI-MACPro-PRA-CQM2018-CDF-CH.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2018-CHL-CH QSSI-MACPro-PRA-CQM2018-CHL-CH.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2018-CIS-CH QSSI-MACPro-PRA-CQM2018-CIS-CH.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2018-CLABSI-CH QSSI-MACPro-PRA-CQM2018-CLABSI-CH.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2018-CPC-CH QSSI-MACPro-PRA-CQM2018-CPC-CH.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2018-DEV-CH QSSI-MACPro-PRA-CQM2018-DEV-CH.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2018-FUH-CH QSSI-MACPro-PRA-CQM2018-FUH-CH.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2018-IMA-CH QSSI-MACPro-PRA-CQM2018-IMA-CH.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2018-LBW-CH QSSI-MACPro-PRA-CQM2018-LBW-CH.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2018-PC02-CH QSSI-MACPro-PRA-CQM2018-PC02-CH.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2018-PDENT-CH QSSI-MACPro-PRA-CQM2018-PDENT-CH.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2018-PPC-CH QSSI-MACPro-PRA-CQM2018-PPC-CH.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2018-SEAL-CH QSSI-MACPro-PRA-CQM2018-SEAL-CH.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2018-W15-CH QSSI-MACPro-PRA-CQM2018-W15-CH.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2018-W34-CH QSSI-MACPro-PRA-CQM2018-W34-CH.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2018-WCC-CH QSSI-MACPro-PRA-CQM2018-WCC-CH.pdf Yes Yes Fillable Fileable
Instruction QSSI-MACPro-PRA-AdditionalNotes.pdf Yes Yes Fillable Fileable
Instruction QSSI-MACPro-PRA-AQM-MIH-DefOfPopulation.pdf Yes Yes Fillable Fileable
Instruction QSSI-MACPro-PRA-CombinedRates.pdf Yes Yes Fillable Fileable
Instruction QSSI-MACPro-PRA-DateRange.pdf Yes Yes Fillable Fileable
Instruction QSSI-MACPro-PRA-CQM_DefOfPopulation.pdf Yes Yes Fillable Fileable
Instruction QSSI-MACPro-PRA-NotReporting.pdf Yes Yes Fillable Fileable
Instruction QSSI-MACPro-PRA-OPM.pdf Yes Yes Fillable Fileable
Instruction QSSI-MACPro-PRA-StatusOfData.pdf Yes Yes Fillable Fileable
Instruction QSSI-MACPro-PRA-TechnicalAssistance.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2018-PQI08 QSSI-MACPro-PRA-AQM2018-PQI08.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2018-PQI15 QSSI-MACPro-PRA-AQM2018-PQI15.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2018-SSA AD QSSI-MACPro-PRA-AQM2018-SAA-AD.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 AQM2018-SSD AD QSSI-MACPro-PRA-AQM2018-SSD-AD.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2017-ADD QSSI-MACPro-PRA-CQM2017-ADD.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2017-AdminScreen QSSI-MACPro-PRA-CQM2017-AdminScreen.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2017-AMB QSSI-MACPro-PRA-CQM2017-AMB.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2017-APC QSSI-MACPro-PRA-CQM2017-APC.pdf Yes Yes Fillable Fileable
Form CMS-10434 #26 CQM2017-APP QSSI-MACPro-PRA-CQM2017-APP.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

56 0
   
State, Local, and Tribal Governments
 
   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 224 0 224 0 0 0
Annual IC Time Burden (Hours) 8,960 0 8,960 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Generic Supporting Statement 26 - Supporting Statement (2019 version 2).docx 07/11/2019
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