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Tribal Consultation State Plan Amendment Template (CMS-10293)

IC 193149 under ICR 201307-0938-027 · OMB 0938-1098.

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Form and Instruction
Form and Instruction
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Tribal Consultation State Plan Amendment Template (CMS-10293)
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10293 State Plan Amendment Template for Trival Consultation Under Title XIX of the Social Security Act Preprint 5006 4-28-10.docx Yes Yes Fillable Fileable

Health Health Care Services

 

37 0
   
State, Local, and Tribal Governments
 
   0 %

  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 37 0 0 0 0 37
Annual IC Time Burden (Hours) 37 0 0 0 0 37
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS-10293 CMS-10293.SHO Letter.doc 05/19/2010
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.