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Federal forms, ICRs, and supporting documents

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GenIC #21 (Extension w/o change): FMAP Claiming State Plan Amendment

IC 229616 under ICR 201712-0938-019 · OMB 0938-1148.

Documents and Forms
Document Name
Document Type
Form and Instruction
Instruction
Form and Instruction
IC Document
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GenIC #21 (Extension w/o change): FMAP Claiming State Plan Amendment
 
New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10398 #21 SPA Attachments: Threshold Methodology for Identification of Applicable FMAP Rates 21 - FMAP Claiming SPA 9-16-13-Attachments.docx Yes Yes Fillable Fileable
Instruction 21 - FMAP Claiming SPA Instructions.docx Yes Yes Printable Only

Health Health Care Services

 

40 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 40 0 40 0 0 0
Annual IC Time Burden (Hours) 160 0 160 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
#21 - Supporting Statement 21 - FMAP Claiming SPA Supporting Statement.docx 12/29/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.