GenIC #27 (Extension w/o change): MAGI Conversion Plan Part 2

Generic Clearance for Medicaid and CHIP State Plan, Waiver, and Program Submissions (CMS-10398)

OMB: 0938-1148

IC ID: 229686

Information Collection (IC) Details

View Information Collection (IC)

GenIC #27 (Extension w/o change): MAGI Conversion Plan Part 2
 
New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10398 #27 Part 2 of Modified Adjusted Gross Income (MAGI) Conversion Plan 27 - Part 2 of Modified Adjusted Gross Income (MAGI) Conversion Plan.docx Yes Yes Fillable Fileable

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 56 0 0 0
Annual IC Time Burden (Hours) 1,120 0 1,120 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
#27 - Supporting Statement 27 - Final Supporting Statement MAGI Conversion Plan II.docx 01/09/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

© 2024 OMB.report | Privacy Policy