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Federal forms, ICRs, and supporting documents

Information Collection

Bundle: GenICs 37 (Managed Care Rate Setting Guidance), 50 (Community First Choice State Plan), and 51 (Fast Track for Section 1115 Medicaid and CHIP Demonstration Extensions)

IC 223503 under ICR 201410-0938-016 · OMB 0938-1148.

Documents and Forms
Document Name
Document Type
Instruction
Instruction
Form
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
IC Document
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Bundle: GenICs 37 (Managed Care Rate Setting Guidance), 50 (Community First Choice State Plan), and 51 (Fast Track for Section 1115 Medicaid and CHIP Demonstration Extensions)
 
New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Medicaid Rate Guide Effective 1.1.17 to 6.30.17 - 10.18.2016.docx Yes Yes Printable Only
Form and Instruction CMS-10398 #51 #51 - 1115(f) Extension State Certification #51 - 1115f extension state certification_09-13-2016.docx Yes Yes Fillable Fileable
Form CMS-10398 #50 Community First Choice (CFC) State Plan Option Preprint #50 - Community First Choice template.8.31.16.docx Yes Yes Fillable Fileable
Instruction #50 - CFC Technical Guide [rev 09-13-2016 by OSORA PRA].docx Yes No Printable Only
Form and Instruction CMS-10398 #51 #51 - Section 1115 Demonstration FAST TRACK Extension Template for Program Changes #51 - Extension with Changes Template_09-13-2016.doc Yes Yes Fillable Printable
Form and Instruction CMS-10398 #51 #51 - 1115(a) Extension State Certification #51 - 1115a extension state certification 09-13-2016.docx Yes Yes Fillable Fileable
Form and Instruction CMS-10398 #51 #51 - 1115(e) Extension State Certification #51 - 1115e extension state certification_09-13-2016.docx Yes Yes Fillable Fileable

Health Health Care Services

 

56 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 113 0 113 0 0 0
Annual IC Time Burden (Hours) 1,158 0 1,158 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
#37 Supporting Stattement: Managed Care Rate Setting Guidance #37 Supporting Statement [rev 09-13-2016 by OSORA PRA].docx 09/13/2016
#37 Crosswalk: Managed Care Rate Setting Guidance #37 - Crosswalk 2016 and 2017 Rate Guide.xlsx 09/13/2016
#50 Supporting Statement: Community First Choice State Plan GenIC #50 - Supporting Statement [rev 09-13-2016 by OSORA PRA].docx 09/13/2016
#51 Supporting Statement: Fast Track Federal Review Process for Section 1115 Medicaid and CHIP Demonstration Extensions GenIC #51 - Supporting Statement rev 09-13-2016 OSORA PRA_SDG edits 9 13 16 -- CLEAN.docx 09/13/2016
Bundled Burden Table Bundled Burden Table (09-13-2016).xlsx 09/13/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.