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GenIC #56 (New): Section 1115 Demonstration: Budget Neutrality Workbook

IC 231323 under ICR 201712-0938-019 · OMB 0938-1148.

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Instruction
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GenIC #56 (New): Section 1115 Demonstration: Budget Neutrality Workbook CMCS
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10398 #56 PMDA Budget Neutrality Workbook Template Copy of BN Template -1115 PMDA-20180425 v2.5.xlsm Yes Yes Fillable Fileable
Instruction Playbook-SU-Budget Neutrality-1115PMDA-20180420-v1.3.docx Yes No Fillable Fileable
Instruction Script Completing a BNW SU version 1.3.docx Yes No Fillable Fileable
Instruction Video - Budget Neutrality Workbook Template.docx Yes Yes Fillable Fileable

Health Health Care Services

 

42 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 307 0 307 0 0 0
Annual IC Time Burden (Hours) 1,897 0 1,897 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Supporting Statement: Budget Neutrality Workbook CMS 1115 Budget Neutrality Workbook - Supporting Statement (rev 05-03-2018 at 0845 am by OSORA PRA).docx 05/03/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.