GenIC #68 (New) - Section 1006(b) of the SUPPORT Act: Medicaid Assisted Treatment (MAT)

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⚠️ Notice: This information collection may be referencing outdated material.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 #68 GenIC #68 (New) - Section 1006(b) of the SUPPORT Act: Medicaid Assisted Treatment (MAT) Form
CMS-10398 #68 SPA Coverage Template for Limitations (Supplement to Att 09-29-2020-1006(b)-SPA Template-Supp to Att.3.1-A (2020 version 3).docx Form
CMS-10398 #68 SPA Coverage Template for Limitations (Supplement to Att 09-29-2020-1006(b)-SPA Template-Supp to Att. 3.1-B (2020 version 3).docx Form
GenIC 68 - Generic Supporting Statement (2020 version 6).docx Generic Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	GenIC #68 (New) - Section 1006(b) of the SUPPORT Act: Medicaid Assisted Treatment (MAT)	Agency IC Tracking Number:	CMCS

IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10398 #68	SPA Coverage Template for Limitations (Supplement to Attachment 3.1-A)	09-29-2020-1006(b)-SPA Template-Supp to Att.3.1-A (2020 version 3).docx		Yes	Yes	Fillable Fileable
Form	CMS-10398 #68	SPA Coverage Template for Limitations (Supplement to Attachment 3.1-B)	09-29-2020-1006(b)-SPA Template-Supp to Att. 3.1-B (2020 version 3).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 56	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	66	66
Annual IC Time Burden (Hours)	4,485	4,485
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Generic Supporting Statement	GenIC 68 - Generic Supporting Statement (2020 version 6).docx	10/27/2020

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