State Plan Under Title XIX of the Social Security Act (Base plan pages)

State Plan Under Title XIX of the Social Security Act (Base plan pages, Attachments, Supplements to Attachments) (CMS-179)

OMB: 0938-0193

IC ID: 7877

Documents and Forms

Document Name Document Type
Form CMS-179 State Plan Under Title XIX of the Social Security Act (Base plan pages) Form and Instruction
CMS-179 Transmittal and Notice of Approval of State Plan Materia CMS 179 Form (e-version).pdf Form and Instruction
CMS-179 2.1 - 2.7 (State) Exhibit A (2).doc Form
CMS-179 2.1 - 2.7 (Territory) Exhibit A1 (2).doc Form
CMS-179 4.19(a) Exhibit AA (2).doc Form
CMS-179 4.19(e) Exhibit AB (2).doc Form
CMS-179 4.19(f) Exhibit AC (2).doc Form
CMS-179 4.19(g) Exhibit AD (2).doc Form
CMS-179 4.19(h) Exhibit AE (2).doc Form
CMS-179 4.19(i) Exhibit AF (2).doc Form
CMS-179 4.19 (k)(1) Exhibit AG (2).doc Form
CMS-179 Attachment 2.2 A and Supplements 1 - 3 Exhibit D and E (2).doc Form
CMS-179 4.19(b): Attachment 4.19 B Exhibit DP Revised 4-9-15.doc Form
CMS-179 (State) Attachment 2.6 A and Supplements 1, 2, 3, 4, 5, Exhibit F and G revision 4-9-15.doc Form
CMS-179 (Territory) Attachment 2.6 A and Supplements 1, 2, 3, 4, Exhibit H and J (2).doc Form
CMS-179 Attachment 4.19-B, Section 24 Exhibit N (2).doc Form
CMS-179 Attachment 4.19 B, Supplement 1 Exhibit O (2).doc Form
CMS-179 4.19(c) Exhibit P (2).doc Form
CMS-179 4.19 (d) Exhibit Y Revision 4-9-15.doc Form
CMS-179 4.31, 4.32, 4.33, and 4.34 Exhibits R S T U (2).doc Form
Crosswalk.doc Crosswalk IC Document