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GenIC #61 - Medicaid Disaster Relief for the COVID-19 National Emergency State Plan Amendment Template and Instructions

IC 240816 under ICR 201712-0938-019 · OMB 0938-1148.

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GenIC #61 - Medicaid Disaster Relief for the COVID-19 National Emergency State Plan Amendment Template and Instructions
 
New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction CMS-10398.GenIC#61 - Medicaid Disaster Relief SPA Instructions (final 3-21-20@755p).docx Yes No Printable Only
Form CMS-10398.GenIC#61 CMS-10398.GenIC#61 - Medicaid Disaster Relief SPA Template CMS-10398#61 - Medicaid Disaster Relief SPA Template Final.docx Yes Yes Fillable Fileable

Health Health Care Services

 

56 0
   
State, Local, and Tribal Governments
 
   0 %

  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 56 0 56 0 0 0
Annual IC Time Burden (Hours) 168 0 168 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS-10398.GenIC#61 - Medicaid Disaster SPA Template and Instructions Supporting Statement CMS-10398.GenIC#61 - Medicaid Disaster SPA Template and Instructions Supporting Statement (final 3-21-20@755p).docx 03/21/2020
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