#36: Same Sex Marriage Policy

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⚠️ Notice: This information collection may be referencing outdated material.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
Form CMS-10398 (#36) #36: Same Sex Marriage Policy Form
CMS-10398 (#36) DOMA Medicaid Eligibility SPA Template DOMA SPA Template [rev 9-11-2014 by OSORA PRA].docx Form
CMS-10398 (#36) DOMA CHIP Eligibility SPA Template DOMA CHIP SPA Template [rev 9-11-2014 by OSORA PRA].docx Form
#36 Same Sex Marriage [Dec 2014].docx #36 Supporting Statement: Same Sex Marriage Policy IC Document

Information Collection (IC) Details

IC Title:	#36: Same Sex Marriage Policy	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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10398 (#36)	DOMA Medicaid Eligibility SPA Template	DOMA SPA Template [rev 9-11-2014 by OSORA PRA].docx		Yes	Yes	Fillable Printable
Form	CMS-10398 (#36)	DOMA CHIP Eligibility SPA Template	DOMA CHIP SPA Template [rev 9-11-2014 by OSORA PRA].docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 56	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	56	56
Annual IC Time Burden (Hours)	56	56
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
#36 Supporting Statement: Same Sex Marriage Policy	#36 Same Sex Marriage [Dec 2014].docx	12/22/2014

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