1 Single State Agency Assurances

Centers for Medicare & Medicaid
Services
CMS eXpedited Life Cycle (XLC)

Medicaid and CHIP Program (MACPro)
A5-Single State Agency Assurances RU PRA
document
Version 1.0
08/21/2017

Document Number: 240-QSSI-MACPro-PRA-A5-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. A5-Single State Agency Assurances Screenshots ............................................... 1
1.1

Section A. Assurances and Section B. Additional Information (optional) ........ 1

List of Figures
Figure 1: Section A and Section B .................................................................................. 1

List of Tables
No table of figures entries found.

A5-Single State Agency Assurances RU PRA document Version 1.0

ii

08/21/2017

CMS XLC

A5-Single State Agency Assurances Screenshots

1. A5-Single State Agency Assurances Screenshots
1.1

Section A. Assurances and Section B. Additional Information
(optional)

Figure 1: Section A and Section B

A5-Single State Agency Assurances RU PRA document Version 1.0

1

08/21/2017