GenIC #43 (Extension w/o change): Section 223 Demonstration Programs to Improve Community Mental Health Services

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⚠️ Notice: This information collection may be referencing outdated material.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
43 - CCBHC Cost Report Instructions 508c 11 10 15.pdf Instruction
43 - State Demonstration Proposal Application and Guidance_100515f_revised 101515_submitted (3).pdf Instruction
43 - Supporting Statement Demonstration Programs CLEAN.docx #43 - Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	GenIC #43 (Extension w/o change): Section 223 Demonstration Programs to Improve Community Mental Health Services	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			43 - State Demonstration Proposal Application and Guidance_100515f_revised 101515_submitted (3).pdf		No		Printable Only
Instruction			43 - CCBHC Cost Report Instructions 508c 11 10 15.pdf		No		Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 97	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	121	121
Annual IC Time Burden (Hours)	7,490	7,490
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
#43 - Supporting Statement	43 - Supporting Statement Demonstration Programs CLEAN.docx	01/11/2018

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