Information Collection Request

Medicaid and CHIP Program (MACPro)

ICR 201301-0938-004 · OMB 0938-1188 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10434 Alternative Benefit Plan (ABP) Form and Instruction New Available
Form CMS-10434 CHIP Administration & Eligibility Form and Instruction New Available
Form CMS-10434 MACPro Home Page Form New Available
Step 4 - Response to Comments_12_7.docx Supplementary Document Uploaded 2013-01-09 Available
ABP Webinar.pdf Supplementary Document Uploaded 2013-01-09 Available
CHIP Eligibility Transcript.pdf Supplementary Document Uploaded 2013-01-09 Available
CHIP Admin Webinar Transcript.pdf Supplementary Document Uploaded 2013-01-08 Available
Medicaid Administration Transcript.pdf Supplementary Document Uploaded 2013-01-08 Available
Initial Application Transcript.pdf Supplementary Document Uploaded 2013-01-08 Available
Homepage Transcript.pdf Supplementary Document Uploaded 2013-01-08 Available
Step 2 - CMS-10434 - Supporting Statement part A [rev 01-24-2013].docx Supporting Statement A Uploaded 2013-01-24 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
205312 Alternative Benefit Plan (ABP) Form and Instruction New
205311 CHIP Administration & Eligibility Form and Instruction New
205310 Medicaid Administration Instruction New
205309 Initial Application Instruction New
205308 MACPro Home Page Form New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2016 36 Months From Approved
280 0 0
2,772 0 0
0 0 0





table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 280 0 0 280 0 0
Annual Time Burden (Hours) 2,772 0 0 2,772 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No