GenIC #63 (Transfer) - 1932(a) State Plan Amendment Template

Generic Clearance for Medicaid and CHIP State Plan, Waiver, and Program Submissions (CMS-10398)

OMB: 0938-1148

IC ID: 241971

Information Collection (IC) Details

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GenIC #63 (Transfer) - 1932(a) State Plan Amendment Template CMCS
 
New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10120 1932(a) State Plan Amendment Template 1932a State Plan Preprint- 508 approved 2020 version 2.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

56 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 12 0 12 0 0 0
Annual IC Time Burden (Hours) 70 0 70 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Generic Supporting Statement 63 - Generic Supporting Statement (2020 version 3).docx 05/26/2020
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