Medicaid Eligibility and Enrollment (EE) Implementation Advanced Planning Document (IAPD) Template

Medicaid Eligibility and Enrollment (EE) Implementation Advanced Planning Document (IAPD) Template (CMS-10536)

OMB: 0938-1268

IC ID: 214452

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Medicaid Eligibility and Enrollment (EE) Implementation Advanced Planning Document (IAPD) Template
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10536 Medicaid Eligibility and Enrollment (EE) Implementation Advanced Planning Document (IAPD) Template Medicaid_EE_IAPD_Template_2015_02_18.pdf Yes Yes Fillable Printable

Health Health Care Services

 

56 0
   
State, Local, and Tribal Governments
 
   100 %

  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 168 168 0 0 0 0
Annual IC Time Burden (Hours) 2,688 2,688 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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