Data Source (Select one) (Several options are listed in the on-line application): If is selected, specify: ‘Other’ Responsible Party for Frequency of data Sampling Approach data collection/generation: (check each that collection/generation (check each that applies) (check each that applies) applies) X State Medicaid Agency Weekly 100% Review X Operating Agency Monthly X Less than 100% Review Sub-State Entity Quarterly X Representative Sample; Confidence Interval =5 Other Annually Specify: X Continuously and Stratified: Describe Ongoing Group: Other Specify: Other Specify: Data Source (Select one) (Several options are listed in the on-line application): If is selected, specify: ‘Other’ Responsible Party for Frequency of data Sampling Approach data collection/generation: (check each that collection/generation (check each that applies) (check each that applies) applies) X State Medicaid Agency Weekly 100% Review X Operating Agency Monthly X Less than 100% Review Sub-State Entity Quarterly X Representative Sample; Confidence Interval =5 Other Annually Specify: X Continuously and Stratified: Describe Ongoing Group: Other Specify: Other Specify: Data Aggregation and Analysis
Data Source (Select one) (Several options are listed in the on-line application): If ‘Other’ is selected, specify: Responsible Party for data collection/generation (check each that applies) Frequency of data collection/generation: (check each that applies) Sampling Approach (check each that applies) X State Medicaid Agency Weekly 100% Review X Operating Agency Monthly X Less than 100% Review Sub-State Entity Quarterly X Representative Sample; Confidence Interval =5 Other Specify: Annually X Continuously and Ongoing Stratified: Describe Group: Other Specify: Other Specify: Data Source (Select one) (Several options are listed in the on-line application): If ‘Other’ is selected, specify: Responsible Party for data collection/generation (check each that applies) Frequency of data collection/generation: (check each that applies) Sampling Approach (check each that applies) X State Medicaid Agency Weekly 100% Review X Operating Agency Monthly X Less than 100% Review Sub-State Entity Quarterly X Representative Sample; Confidence Interval =5 Other Specify: Annually X Continuously and Ongoing Stratified: Describe Group: Other Specify: Other Specify: Data Aggregation and Analysis