State Plan Pre-print implementing Section 6087 of the DRA: Optional Self-Direction PAS Program (Cash and Counseling) CMS-10234

State Plan Pre-print implementing Section 6087 of the DRA: Optional Self Direction PAS Program (Cash and Counseling) CMS-10234

OMB: 0938-1024

IC ID: 181537

Information Collection (IC) Details

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State Plan Pre-print implementing Section 6087 of the DRA: Optional Self-Direction PAS Program (Cash and Counseling) CMS-10234
 
No New
 
Required to Obtain or Retain Benefits
 
42 CFR 1396

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10234 State Plan Pre-print spapreprint 5 4 07 PRA version.doc No No Fillable Printable
Instruction CMS-10234 SMD Letter Self Direction.doc No No Printable Only

Health Health Care Services

 

56 0
   
State, Local, and Tribal Governments
 
   95 %

  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 56 0 0 0 0
Annual IC Time Burden (Hours) 1,120 1,120 0 0 0 0
Annual IC Cost Burden (Dollars) 56,000 56,000 0 0 0 0

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