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 (CMS-10120)

OMB: 0938-0933

IC ID: 8781

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1932 State Plan Amendment Template, State Plan Requirements, and Supporting Regulations in 42 CFR 438.50
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10120 1932 State Plan Amendment Template CMS-10120 SPA-051004.doc Yes Yes Fillable Fileable

Health Health Care Services

 

10 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 10 0 0 0 0 10
Annual IC Time Burden (Hours) 100 0 0 0 0 100
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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