GenIC #53 (New): Section 1115 Substance Use Disorder (SUD) Demonstration: Guide for Developing Implementation Plan Protocols

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⚠️ Notice: This information collection may be referencing outdated material.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
Form CMS-10398 #53 GenIC #53 (New): Section 1115 Substance Use Disorder (SUD) Demonstration: Guide for Developing Implementation Plan Protocols Form and Instruction
53 - Opioid and other SUD 1115s smd #17-003.pdf Other-SMD Letter 17-003 (Strategies
CMS-10398 #53 Section 1115 Substance Use Disorder (SUD) Demonstration: 53 - SUD Implementation Plan Template 11 17 2017 [rev OSORA PRA].docx Form and Instruction
GenIC 53 - Supporting Statement [rev#3 12-14-2017 by OSORA PRA].docx Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	GenIC #53 (New): Section 1115 Substance Use Disorder (SUD) Demonstration: Guide for Developing Implementation Plan Protocols	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
Form and Instruction	CMS-10398 #53	Section 1115 Substance Use Disorder (SUD) Demonstration: Guide for Developing Implementation Plan Protocols	53 - SUD Implementation Plan Template 11 17 2017 [rev OSORA PRA].docx		Yes	Yes	Fillable Fileable
Other-SMD Letter 17-003 (Strategies to Address the Opioid Epidemic)			53 - Opioid and other SUD 1115s smd #17-003.pdf		No		Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 49	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	49	49
Annual IC Time Burden (Hours)	784	784
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement	GenIC 53 - Supporting Statement [rev#3 12-14-2017 by OSORA PRA].docx	03/01/2018

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