#30: State Reporting Medicaid Payment Suspension

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

OMB: 0938-1148

IC ID: 214360

Information Collection (IC) Details

View Information Collection (IC)

#30: State Reporting Medicaid Payment Suspension
 
New
 
Required to Obtain or Retain Benefits
 
42 CFR 455.23

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability

Health Health Care Services

 

35 0
   
State, Local, and Tribal Governments
 
   100 %

  Requested 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 1,040 0 1,040 0 0 0
Annual IC Time Burden (Hours) 1,040 0 1,040 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
#30 Supporting Statement: State Reporting Medicaid Payment Suspension #30 Supporting Statement - State Reporting Medicaid Payment Suspension [Dec 2014].docx 12/23/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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