Information Collection

GenIC # 43 - Section 223 Demonstration Programs to Improve Community Mental Health Services (CMS-10398)

IC 219037 under ICR 201410-0938-016 · OMB 0938-1148.

⚠️ Notice: This information collection may be referencing outdated material.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 (#43) GenIC # 43 - Section 223 Demonstration Programs to Improve Community Mental Health Services (CMS-10398) Form
CCBHC Cost Report Instructions 508c 11 10 15.pdf Instruction
CMS-10398 (#43) CCMHC Cost Report CCBHC 508 Cost Report 11.10.15.xlsx Form
CMS-10398 (#43) State Demonstration Proposal Application and Guidance State Demonstration Proposal Application and Guidance_100515f_revised 101515_submitted (3).pdf Form and Instruction
CCBHC Cost Reporting - Combined Comment and Response to Public Comments [rev 11-16-2015 by OSORA PRA].docx Cost Report - Public Comment and CMS Response IC Document
Crosswalk - Cost report and instructions revisions 11.10.15.xlsx Cost Report - Crosswalk IC Document
GenIC 43 Supporting Statement - Section 223 Demonstration Programs [rev 11-19-2015 by OSORA PRA].docx Supporting Statement IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	GenIC # 43 - Section 223 Demonstration Programs to Improve Community Mental Health Services (CMS-10398)	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10398 (#43)	CCMHC Cost Report	CCBHC 508 Cost Report 11.10.15.xlsx	Yes	Yes	Fillable Printable
Instruction			CCBHC Cost Report Instructions 508c 11 10 15.pdf	No		Printable Only
Form and Instruction	CMS-10398 (#43)	State Demonstration Proposal Application and Guidance	State Demonstration Proposal Application and Guidance_100515f_revised 101515_submitted (3).pdf	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 97	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	121	121
Annual IC Time Burden (Hours)	7,490	7,490
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Cost Report - Public Comment and CMS Response	CCBHC Cost Reporting - Combined Comment and Response to Public Comments [rev 11-16-2015 by OSORA PRA].docx	11/19/2015
Cost Report - Crosswalk	Crosswalk - Cost report and instructions revisions 11.10.15.xlsx	11/19/2015
Supporting Statement	GenIC 43 Supporting Statement - Section 223 Demonstration Programs [rev 11-19-2015 by OSORA PRA].docx	11/19/2015

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