GenIC #55 (New): Limit on Federal Financial Participation for Durable Medical Equipment in Medicaid

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⚠️ Notice: This information collection may be referencing outdated material.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 #55 GenIC #55 (New): Limit on Federal Financial Participation for Durable Medical Equipment in Medicaid Form
Instructions for the State Fee Schedule Drop spreadsheet-3-20-18.docx Instruction
CMS-10398 #55 State Fee Schedule Drop State Fee Schedule Drop-3-21-18.xlsx Form
Crosswalk-DMEchanges-3-27-18.xlsx Crosswalk IC Document
Instructions for the State Fee Schedule Drop spreadsheet-TRACK CHANGES.docx Instructions (Track Changes) IC Document
1k2-917g-qdjy - Comment.pdf Public Comment: 1k2-917g-qdjy IC Document
1k2-9138-nado - Comment.pdf Public Comment: 1k2-9138-nado IC Document
1k2-9176-k8w4 - Combined Cover and Comment.pdf Public Comment: 1k2-9176-k8w4 IC Document
k2-9159-fleh - Combined Cover and Comment.pdf Public Comment: 1k2-9159-fleh IC Document
GenIC #55 - Supporting Statement rev 04-18-2018 by OSORA PRA-CLEAN.docx Supporting Statement IC Document
Letter to summarize the 60 day comments on DME limit on FFP collection of information.docx Response to 60-day Comments IC Document

Information Collection (IC) Details

IC Title:	GenIC #55 (New): Limit on Federal Financial Participation for Durable Medical Equipment in Medicaid	Agency IC Tracking Number:	CMCS

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	CMS-10398 #55	State Fee Schedule Drop	State Fee Schedule Drop-3-21-18.xlsx		Yes	Yes	Fillable Fileable
Instruction			Instructions for the State Fee Schedule Drop spreadsheet-3-20-18.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 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	56	56
Annual IC Time Burden (Hours)	448	448
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Crosswalk	Crosswalk-DMEchanges-3-27-18.xlsx	04/18/2018
Instructions (Track Changes)	Instructions for the State Fee Schedule Drop spreadsheet-TRACK CHANGES.docx	04/18/2018
Public Comment: 1k2-917g-qdjy	1k2-917g-qdjy - Comment.pdf	04/18/2018
Public Comment: 1k2-9138-nado	1k2-9138-nado - Comment.pdf	04/18/2018
Public Comment: 1k2-9176-k8w4	1k2-9176-k8w4 - Combined Cover and Comment.pdf	04/18/2018
Public Comment: 1k2-9159-fleh	k2-9159-fleh - Combined Cover and Comment.pdf	04/18/2018
Supporting Statement	GenIC #55 - Supporting Statement rev 04-18-2018 by OSORA PRA-CLEAN.docx	04/18/2018
Response to 60-day Comments	Letter to summarize the 60 day comments on DME limit on FFP collection of information.docx	04/18/2018

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