Information Collection

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

IC 241474 under ICR 201712-0938-019 · OMB 0938-1148.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1148 can be found here:

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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.3â 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 %

table that charts list of burden
	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

table that charts IC Documents
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.