GenIC #1 - Initial Application

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

OMB: 0938-1188

IC ID: 220807

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Document Name
Document Type
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Instruction
Instruction
Instruction
Instruction
Instruction
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Instruction
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IC Document
Information Collection (IC) Details

View Information Collection (IC)

GenIC #1 - Initial Application
 
Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10434 (#1) Initial Application GenIC #1 Screen Shots - Initial Application.pdf Yes Yes Fillable Printable
Form CMS-10434 (#1) Initial Application (SPA Administration) GenIC #1 Screen Shots - SPA Admin.pdf Yes Yes Fillable Printable
Form CMS-10434 (#1) MACPro Homepage GenIC #1 - MACPro Home Page.jpg Yes Yes Fillable Printable
Instruction #1 - IG_A1-Designation and Authority_R1_Final_11-30-12.docx No   Printable Only
Instruction #1 - IC_A2-Organization and Administration_R1_Final_11-30-12.docx No   Printable Only
Instruction #1 - IG_A3-Assurances_R1_Final_11-30-12.docx No   Printable Only
Instruction #1 - IG_I1_State Information_R1_Draft_11-30-12.docx No   Printable Only
Instruction #1 - IG_I2 - Medicaid State Plan-Specific Submission Data_R1_Draft_11-30-12.docx No   Printable Only
Instruction #1 - IG_I4 - CHIP Amendment Submission_R1 Final_11-30-12.docx No   Printable Only
Instruction #1 - IG_I5 - Public Comment_R1_Draft_11-30-12.docx No   Printable Only
Instruction #1 - IG_I6 - Tribal Input_R1_Draft_11-30-12.docx No   Printable Only

Health Health Care Services

 

56 0
   
State, Local, and Tribal Governments
 
   100 %

  Requested 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 0 56
Annual IC Time Burden (Hours) 476 0 0 0 0 476
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
GenIC #1 - Supporting Statement (Initial Application) GenIC # 1 - Supporting Statement Initial Application Templates [rev 03-28-2016 by OSORA PRA].docx 03/30/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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