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State Plan Template to Implement Section 6062 of the DRA (Opportunity for families of Disabled Children to Purchase Medicaid Coverage for Such Children) CMS-10232

IC 184270 under ICR 201105-0938-010 · OMB 0938-1045.

Documents and Forms
Document Name
Document Type
Other-State Plan Preprint
IC Document
Information Collection (IC) Details

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State Plan Template to Implement Section 6062 of the DRA (Opportunity for families of Disabled Children to Purchase Medicaid Coverage for Such Children) CMS-10232
 
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
Other-State Plan Preprint CMS-10232 FOA Preprint for PRA package- 2-16-11 _3_.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

56 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) 60 0 0 0 0 60
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS-10232 Crosswalk CMS-10232 Draft FOA Preprint Crosswalk 2-16-11.pdf 05/23/2011
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.