1 Application

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

Medicaid and CHIP Program (MACPro)
S94a-Application PRA document
Version 1.0
08/17/2017

Document Number: 208-QSSI-MACPro-PRA-S94a-D
Contract Number: HHSM-500-2007-00024I: HHSM-500-T0014

CMS XLC

Table of Contents

Table of Contents
1. S94a-Application – Screenshots ............................................................................ 1
1.1

Application....................................................................................................... 1

List of Figures
Figure 1: Application - 1 .................................................................................................. 1
Figure 2: Application – 2.................................................................................................. 1
Figure 3: Application – 3.................................................................................................. 2
Figure 4: Application – 4.................................................................................................. 2
Figure 5: Application – 5.................................................................................................. 3
Figure 6: Application – 6.................................................................................................. 3
Figure 7: Application – 7.................................................................................................. 4
Figure 8: Application – 8.................................................................................................. 4

S94a-Application PRA document Version 1.0

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S94a-Application – Screenshots

1. S94a-Application – Screenshots
1.1

Application

Figure 1: Application - 1

Figure 2: Application – 2

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S94a-Application – Screenshots

Figure 3: Application – 3

Figure 4: Application – 4

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S94a-Application – Screenshots

Figure 5: Application – 5

Figure 6: Application – 6

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S94a-Application – Screenshots

Figure 7: Application – 7

Figure 8: Application – 8

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