Information Collection #18: Alternative Benefit Plans

Generic Clearance for Medicaid and CHIP State Plan, Waiver, and Program Submissions

OMB: 0938-1148

IC ID: 207634

Information Collection (IC) Details

View Information Collection (IC)

Information Collection #18: Alternative Benefit Plans
 
New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10398 (#18) Mock-up of Interim Form for Alternative Benefit Plans ABP MockUp_Final_7_2_13 [rev 7-3-2013 by OSORA PRA].docx Yes Yes Fillable Printable

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 56 0 0 0 0 0
Annual IC Time Burden (Hours) 448 0 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Supporting Statement Alternative Benefit Plans Supporting Statement [rev 7-3-2013 by OSORA PRA].docx 07/03/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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