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Federal forms, ICRs, and supporting documents

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State Plan preprint for Integrated Medicare and Medicaid Programs (CMS-10251)

IC 184093 under ICR 201105-0938-011 · OMB 0938-1047.

Documents and Forms
Document Name
Document Type
Instruction
Form
IC Document
Information Collection (IC) Details

View Information Collection (IC)

State Plan preprint for Integrated Medicare and Medicaid Programs (CMS-10251)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Integrated Care Preprint Instructions 1-16-08 revisions.doc No No Paper Only
Form CMS-10251 State Plan Preprint for Integrated Care Programs Integrated Care Preprint 1-16-08 clean copy.doc Yes Yes Fillable Fileable

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 10 0 0 -20 0 30
Annual IC Time Burden (Hours) 200 0 0 -400 0 600
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
SMD Letter CMS-10251 SMD on IC Preprint.doc 02/19/2008
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.