OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Bundle: PERM Pilot (#20), Same Sex Marriage (#36), and Managed Care Rate Setting (#37)

IC 213094 under ICR 201111-0938-009 · OMB 0938-1148.

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

View Information Collection (IC)

Bundle: PERM Pilot (#20), Same Sex Marriage (#36), and Managed Care Rate Setting (#37)
 
New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10398 (#20) User Guide - PERM Round 1 Findings Submission User Guide Round 1 Findings Submission [rev 9-11-2014 by OSORA PRA].docx Yes Yes Fillable Printable
Form and Instruction CMS-10398 (#20) User Guide - PERM Round 2 Proposal Submission User Guide Round 2 Proposal Submission [rev 9-11-2014 by OSORA PRA].docx Yes Yes Fillable Printable
Form CMS-10398 (#36) DOMA Same Sex CHIP Template DOMA CHIP SPA Template [rev 9-11-2014 by OSORA PRA].docx Yes Yes Fillable Printable
Form CMS-10398 (#36) DOMA Same Sex Medicaid Template DOMA SPA Template [rev 9-11-2014 by OSORA PRA].docx Yes Yes Fillable Printable
Instruction 2015 Medicaid Managed Care Rate Guidance 09-3-14.pdf Yes Yes Fillable Printable

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

Title Document Date Uploaded
Supporting Statement - PERM Pilot Supporting Statement - PERM Pilot Rounds 1 and 2 [rev 9-11-2014 by OSORA PRA].docx 09/11/2014
Crosswalk - PERM Round 1 and 2 Proposal Submission Crosswalk for round 1 and 2 proposal.xlsx 09/11/2014
PERM SHO Letter StateHealthOfficialLetter (3).pdf 09/11/2014
Supporting Statement - DOMA Same Sex Supporting Statement (# 36) - Same Sex Marriage rev 9-11-2014 by OSORA.docx 09/11/2014
Supporting Statement - Managed Care Rate Setting Supporting Statement 2015 Managed Care Rate Setting Guidance.docx 09/11/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.