Medicaid Use Report

Medicaid Use Report

OMB: 0960-0267

IC ID: 9170

Documents and Forms
Document Name
Document Type
Other-MSSICS
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Medicaid Use Report
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 416.268

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-MSSICS MSSICS Screens.doc Yes Yes Fillable Fileable Signable

Income Security General Retirement and Disability

 

60,000 0
   
Individuals or Households
 
   98 %

  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 60,000 0 0 0 0 60,000
Annual IC Time Burden (Hours) 3,000 0 0 0 0 3,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
PRA and PA Statments PRA and PA Statments.doc 12/06/2011
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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