GenIC #29 (Extension w/o change): Medicaid Cost Sharing

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1148 can be found here:

Documents and Forms

Document Name Document Type
29 - IG_G1-Cost Sharing Requirements_Draft_MMDL_2-3-14(final clean).pdf Instruction
29 - IG_G2a_Cost Sharing Amounts-CN_Draft_MMDL_2-3-14(final clean).pdf Instruction
29 - IG_G2b_Cost Sharing Amounts-MN_Draft_MMDL_2-3-14(final clean).pdf Instruction
29 - IG_G2c-Cost Sharing Amounts-Targeting_Draft_2-3-14(final clean) (4).pdf Instruction
29 - IG_G3-Cost Sharing Limitations_Draft_MMDL_2-3-14(final clean) (3).pdf Instruction
CMS-10398 #29 Medicaid Premiums and Cost Sharing 29 - Medicaid Cost Sharing_FINAL_2-3-14_clean2.pdf Form
29 - Final Supporting Statement Medicaid Cost Sharing.docx #29 - Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	GenIC #29 (Extension w/o change): Medicaid Cost Sharing	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			29 - IG_G1-Cost Sharing Requirements_Draft_MMDL_2-3-14(final clean).pdf	Yes	Yes	Fillable Fileable
Instruction			29 - IG_G2a_Cost Sharing Amounts-CN_Draft_MMDL_2-3-14(final clean).pdf	Yes	Yes	Fillable Fileable
Instruction			29 - IG_G2b_Cost Sharing Amounts-MN_Draft_MMDL_2-3-14(final clean).pdf	Yes	Yes	Fillable Fileable
Instruction			29 - IG_G2c-Cost Sharing Amounts-Targeting_Draft_2-3-14(final clean) (4).pdf	Yes	Yes	Fillable Fileable
Instruction			29 - IG_G3-Cost Sharing Limitations_Draft_MMDL_2-3-14(final clean) (3).pdf	Yes	Yes	Fillable Fileable
Form	CMS-10398 #29	Medicaid Premiums and Cost Sharing	29 - Medicaid Cost Sharing_FINAL_2-3-14_clean2.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
#29 - Supporting Statement	29 - Final Supporting Statement Medicaid Cost Sharing.docx	01/09/2018

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.