Medicaid Report on Payables and Receivables

Medicaid Report on Payables and Receivables

OMB: 0938-0697

IC ID: 43663

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Medicaid Report on Payables and Receivables
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction CMS-R-199.MedicaidInstructions508.pdf Yes Yes Fillable Fileable
Form R-199 Medicaid Reporting CMS-R-199 Form(2016).doc Yes No 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 56 0 0 0 56 0
Annual IC Time Burden (Hours) 392 0 0 0 392 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.

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