Information Collection

GenIC 22 (Revision): Health Home State Plan Amendment (SPA)

IC 254721 under ICR 201908-0938-015 · OMB 0938-1188.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1188 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form A1 - A5, HH1 - HH9 1945 Health Home SPA Templates GenIC 22 (Revision): Health Home State Plan Amendment (SPA)	Form
Form HH1A 1945A Health Homes Introduction GenIC 22 (Revision): Health Home State Plan Amendment (SPA)	Form
Form HH2A 1945A Population and Enrollment GenIC 22 (Revision): Health Home State Plan Amendment (SPA)	Form
Form HH3A 1945A Geographic Limitations GenIC 22 (Revision): Health Home State Plan Amendment (SPA)	Form
Form HH4A 1945A Health Homes Services GenIC 22 (Revision): Health Home State Plan Amendment (SPA)	Form
Form HH5A 1945A Health Homes Providers GenIC 22 (Revision): Health Home State Plan Amendment (SPA)	Form
Form HH6A 1945A Health Homes Delivery Systems GenIC 22 (Revision): Health Home State Plan Amendment (SPA)	Form
Form HH7A 1945A Health Homes Payment Methodologies GenIC 22 (Revision): Health Home State Plan Amendment (SPA)	Form
Form HH8A 1945A Health Homes Monitoring, Quality Measurement, and Evaluation GenIC 22 (Revision): Health Home State Plan Amendment (SPA)	Form
Form HH9A 1945A Health Homes Program Termination GenIC 22 (Revision): Health Home State Plan Amendment (SPA)	Form
Form I2A 1945A Submission Summary GenIC 22 (Revision): Health Home State Plan Amendment (SPA)	Form
Form I3A 1945A Public Comment GenIC 22 (Revision): Health Home State Plan Amendment (SPA)	Form
Form I3aA 1945A Public Notice-Process GenIC 22 (Revision): Health Home State Plan Amendment (SPA)	Form
Form I4A 1945A Tribal Input GenIC 22 (Revision): Health Home State Plan Amendment (SPA)	Form
Form I5A 1945A Other Comment GenIC 22 (Revision): Health Home State Plan Amendment (SPA)	Form

Information Collection (IC) Details

Record metadata
IC Title	GenIC 22 (Revision): Health Home State Plan Amendment (SPA)