GenIC #50 (Extension w/o change): Community First Choice State Plan

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⚠️ Notice: This information collection may be referencing outdated material.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
50 - CFC Technical Guide 04-25-17.docx Instruction
CMS-10398 #50 Community First Choice (CFC) State Plan pre-print 50 - Template Community First Choice 04-25-17.docx Form
50 - Supporting Statement Community First Choice 04-25-17 - CLEAN.docx #50 - Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	GenIC #50 (Extension w/o change): Community First Choice State Plan	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			50 - CFC Technical Guide 04-25-17.docx		Yes	Yes	Fillable Fileable
Form	CMS-10398 #50	Community First Choice (CFC) State Plan pre-print	50 - Template Community First Choice 04-25-17.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 56	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	56	56
Annual IC Time Burden (Hours)	560	560
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
#50 - Supporting Statement	50 - Supporting Statement Community First Choice 04-25-17 - CLEAN.docx	01/12/2018

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