Information Collection

Recovery Act - Reporting Requirements for States Under FMAP Increase and TMA Provisions (CMS-10295)

IC 191135 under ICR 201607-0938-012 · OMB 0938-1073.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10295 Recovery Act - Reporting Requirements for States Under FMAP Increase and TMA Provisions (CMS-10295)	Form and Instruction
CMS-10295 State Report on the Transitional Medical Assistance Copy of ARRA-Sec-5004-State-Report-3 (2).pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10295	State Report on the Transitional Medical Assistance	Copy of ARRA-Sec-5004-State-Report-3 (2).pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	400	400
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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