Information Collection

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

IC 229737 under ICR 201712-0938-019 · OMB 0938-1148.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.