Information Collection Request

Medicaid and CHIP Program (MACPro) (CMS-10434)

ICR 201603-0938-022 · OMB 0938-1188 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10434 (#3) GenIC #3 - Alternative Benefit Plans (ABPs) Form New Available
Form CMS-10434 (#2) GenIC #2 - CHIP State Plan Eligibility Form New Available
Form CMS-10434 (#1) GenIC #1 - Initial Application Form New Available
CMS-10434 - Supporting Statement A [rev 03-28-2016 by OSORA PRA].docx Supporting Statement A Uploaded 2016-03-30 Available
MACPro PRA Hours Used and Upcoming Packages 03-22-16.xlsx Supplementary Document Uploaded 2016-03-30 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
220810 GenIC #3 - Alternative Benefit Plans (ABPs) Form New
220809 GenIC #2 - CHIP State Plan Eligibility Form New
220807 GenIC #1 - Initial Application Form New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
08/31/2019 36 Months From Approved 08/31/2016
280 0 280
2,772 0 2,772
0 0 0





table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 280 280 0 0 0 0
Annual Time Burden (Hours) 2,772 2,772 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No