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1932 State Plan Amendment Template, State Plan Requirements, and Supporting Regulations in 42 CFR 438.50
1932 State Plan Amendment Template, State Plan Requirements, and Supporting Regulations in 42 CFR 438.50
OMB: 0938-0933
IC ID: 8781
OMB.report
HHS/CMS
OMB 0938-0933
ICR 200411-0938-001
IC 8781
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0933 can be found here:
2017-04-21 - Revision of a currently approved collection
2014-02-26 - Revision of a currently approved collection
Documents and Forms
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Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
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IC Title:
1932 State Plan Amendment Template, State Plan Requirements, and Supporting Regulations in 42 CFR 438.50
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
CMS-10120
Yes
Yes
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
10
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
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
10
0
10
0
0
0
Annual IC Time Burden (Hours)
100
0
100
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.