GenIC #60 (New): SUPPORT Act Survey of Housing-Related Supports and Services Under Medicaid to Individuals with Substance Use Disorders

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⚠️ Notice: This information collection may be referencing outdated material.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 #60 GenIC #60 (New): SUPPORT Act Survey of Housing-Related Supports and Services Under Medicaid to Individuals with Substance Use Disorders Form and Instruction
60 - Attachment A.2 Glossary of Terms_04_05_20.docx Instruction
60 - Attachment A.3— Cover Letter_04_05_20.docx Other-Cover Letter
CMS-10398 #60 State Technical Assistance Needs Assessment Survey 60 - Attachment A.1 State Technical Assistance Needs Assessment (version 2).docx Form and Instruction
60 - Generic Supporting Statement (2020 version 3).docx Generic Supporting Statement IC Document
60 - Supporting Statement B (2020 version 2).docx Supporting Statement B IC Document

Information Collection (IC) Details

IC Title:	GenIC #60 (New): SUPPORT Act Survey of Housing-Related Supports and Services Under Medicaid to Individuals with Substance Use Disorders	Agency IC Tracking Number:	CMCS

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10398 #60	State Technical Assistance Needs Assessment Survey	60 - Attachment A.1 State Technical Assistance Needs Assessment (version 2).docx	Yes	Yes	Fillable Fileable
Instruction			60 - Attachment A.2 Glossary of Terms_04_05_20.docx	Yes	No	Printable Only
Other-Cover Letter			60 - Attachment A.3— Cover Letter_04_05_20.docx	No		Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 51	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	51	51
Annual IC Time Burden (Hours)	26	26
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Generic Supporting Statement	60 - Generic Supporting Statement (2020 version 3).docx	04/22/2020
Supporting Statement B	60 - Supporting Statement B (2020 version 2).docx	04/22/2020

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