Recovery Act - Reporting Requirements for States Under FMAP Increase and TMA Provisions (CMS-10295)

Recovery Act - Reporting Requirements for States Under FMAP Increase and TMA Provisions (CMS-10295)

OMB: 0938-1073

IC ID: 191135

Information Collection (IC) Details

View Information Collection (IC)

Recovery Act - Reporting Requirements for States Under FMAP Increase and TMA Provisions (CMS-10295)
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10295 State Report on the Use of Increase FMAP Section 5001 of ARRA 08-20-09 ARRA-Sec-5001-State-Report-3.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10295 State Report on the Transitional Medical Assistance Section 5004 of ARRA 08-20-09 ARRA-Sec-5004-State-Report-3.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

50 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 200 0 0 0 0 200
Annual IC Time Burden (Hours) 600 0 0 0 0 600
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Disclosure Statement for Section 5001 Disclosure Statement for Section 5001.DOC 09/16/2009
Disclosure Statement for Section 5004 Disclosure Statement for Section 5004.DOC 09/16/2009
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

© 2024 OMB.report | Privacy Policy