CHIP Administration & Eligibility

Medicaid and CHIP Program (MACPro)

OMB: 0938-1188

IC ID: 205311

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Information Collection (IC) Details

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CHIP Administration & Eligibility
 
No New
 
Required to Obtain or Retain Benefits
 
42 CFR 430.12

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10434 CHIP Administration CHIP Admin Form.pdf Yes Yes Fillable Fileable
Instruction IG_CA1 - Program Type Designation_R1_Final_ 11-30-12.docx Yes No Printable Only
Instruction IG_CA2 - Designation and Authority_R1_Final_11-30-12.docx Yes No Printable Only
Instruction IG_CA3- Organization and Administation_R1_Final_ 11-30-12.docx Yes No Printable Only
Instruction IG_CA4 - CHIP State Plan Administration-Assurances_R1_Draft_11-30-12.docx Yes No Printable Only
Instruction IG_CHIP Admin Introduction_R1_Final_11-30-12.docx Yes No Printable Only
Instruction IG_CHIP Eligibility Introduction_R1_Final_11-30-12.docx Yes No Printable Only
Instruction IG_CS3 - Medicaid Expansion_R1_Final_11-30-12.docx Yes No Printable Only
Instruction IG_CS4 - Separate CHIP Covered Groups_R1_Final_11-30-12.docx Yes No Printable Only
Instruction IG_CS5 - Completion of Covered Groups_R1_Final_11-30-12 .docx Yes No Printable Only
Instruction IG_CS6 - Income Standards_R1_Final_11-30-12.docx Yes No Printable Only
Instruction IG_CS7 - Targeted Low-Income Child_R1_Final_11-30-12.docx Yes No Printable Only
Instruction IG_CS8 - Targeted Low-Income Pregnant Women_R1_Final_ 11-30-12.docx Yes No Printable Only
Instruction IG_CS9 - Coverage from Conception to Birth_R1_Final_11-30-12.docx Yes No Printable Only
Instruction IG_CS10- Children with Access to Public Employee Coverage_R1_Draft_11-30-12.docx Yes No Printable Only
Instruction IG_CS11 - Pregnant Women Who Have Access to Public Employee Coverage_R1_Draft_11-30-12.docx Yes No Printable Only
Instruction IG_CS12 - Dental Only Supplemental Coverage_R1_Final_ 11-30-12.docx Yes No Printable Only
Instruction IG_CS13 - Deemed Newborns_R1_Draft_11-30-12.docx Yes No Printable Only
Instruction IG_CS14 - Children Inelig for Medicaid as a Result of the Elim of Income Disregards_R1_Final_11-30-12.docx Yes No Printable Only
Instruction IG_CS15 - MAGI-Based Income Methodologies_R1_Final_11-30-12.docx Yes No Printable Only
Instruction IG_CS16 - Spenddown_R1_Final_11-30-12.docx Yes No Printable Only
Instruction IG_CS17 - Non-Financial-Residency_R1_Final_11-30-12.docx Yes No Printable Only
Instruction IG_CS18 - Non-Financial-Citizenship_R1_Final_11-30-12.docx Yes No Printable Only
Instruction IG_CS19 - Non-Financial-Social Security Number_R1_Draft_11-30-12.docx Yes No Printable Only
Instruction IG_CS20 - Non-Financial-Substitution of Coverage_R1_Draft_11-30-12.docx Yes No Printable Only
Instruction IG_CS21 - Non-Financial-Non-Payment of Premiums_R1_Draft_11-30-12.docx Yes No Printable Only
Instruction IG_CS22 - Non-Financial Requirements_R1_Draft_11-30-12.docx Yes No Printable Only
Instruction IG_CS23 - Non-Financial Requirement-Other Eligibility Standards_R1_Final_11-30-12.docx Yes No Printable Only
Instruction IG_CS24 - Eligibility Processing_R1_Final_11-30-12.docx Yes No Printable Only
Instruction IG_CS25 - Beginning Date of Eligibility_R1_Final_11-30-12.docx Yes No Printable Only
Instruction IG_CS26 - Ending Dates of Eligibility_R1_Final_11-30-12.docx Yes No Printable Only
Instruction IG_CS27 - Continuous Eligibility_R1_Final_11-30-12.docx Yes No Printable Only
Instruction IG_CS28 - Presumptive Eligibility for Children_R1_Draft_11-30-12.docx Yes No Printable Only
Instruction IG_CS29 - Presumptive Eligibility for Pregnant Women_R1_Draft_11-30-12.docx Yes No Printable Only
Instruction IG_CS30 - Qualified Entities_R1_Final_11-30-12.docx Yes No Printable Only
Instruction IG_CS32 - Express Lane Eligibility_R1_Final_11-30-12.docx Yes No Printable Only
Instruction IG_CS33 - Express Lane Agencies_R1_Final_11-30-12.docx Yes No Printable Only
Instruction IG_CS34 - Express Lane Eligibility Components_R1_Final_11-30-12.docx Yes No Printable Only
Form and Instruction CMS-10434 CHIP Eligibility CHIP Eligibility Form.pdf Yes Yes Fillable Fileable

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 56 0 0 0
Annual IC Time Burden (Hours) 1,568 0 1,568 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CHIP Administration - Webinar Transcript CHIP Admin Webinar Transcript.pdf 01/08/2013
CHIP Eligibility - Webinar Transcript CHIP Eligibility Transcript.pdf 01/09/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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