#31: Statewide HCBS Transition Plans

Generic Clearance for Medicaid and CHIP State Plan, Waiver, and Program Submissions (CMS-10398)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1148 can be found here:

Documents and Forms

Document Name Document Type
Heightened Scrutiny in Transition Plan 5-14-2014.docx Instruction
State Transition Plan for Compliance (2).docx Instruction
CMS-10398 (#31) Sample Template For State Settings’ Analysis Template for State Settings Analysis.docx Form
#31 Statewide HCBS Transistion Plan Spporting Statement [Dec 2014].docx #31 Supporting Statement: Statewide HCBS Transition Plans IC Document

Information Collection (IC) Details

IC Title:	#31: Statewide HCBS Transition Plans	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Heightened Scrutiny in Transition Plan 5-14-2014.docx	No		Printable Only
Instruction			State Transition Plan for Compliance (2).docx	No		Printable Only
Form	CMS-10398 (#31)	Sample Template For State Settings’ Analysis	Template for State Settings Analysis.docx	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 48	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	48	48
Annual IC Time Burden (Hours)	2,016	2,016
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
#31 Supporting Statement: Statewide HCBS Transition Plans	#31 Statewide HCBS Transistion Plan Spporting Statement [Dec 2014].docx	12/22/2014

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.