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Federal forms, ICRs, and supporting documents

Information Collection

PACE State Plan Option Preprint (CMS-10227)

IC 181912 under ICR 202001-0938-017 · OMB 0938-1027.

Documents and Forms
Document Name
Document Type
Instruction
Form
IC Document
IC Document
Information Collection (IC) Details

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PACE State Plan Option Preprint (CMS-10227)
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction SMDL-11-09-00.tif No No Printable Only
Form CMS-10227 PACE State Plan Amendment Pre-Print CMS-10227 SPA PACE PREPRINT (2020 version 3).rtf Yes Yes Fillable Printable

Health Health Care Services

 

21 0
   
State, Local, and Tribal Governments
 
   0 %

  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 7 0 0 0 0 7
Annual IC Time Burden (Hours) 140 0 0 0 0 140
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk - Preprint Crosswalk PACE SPA Preprint Enclosure 7 (2020 version 3).xlsx 05/18/2020
Track Change - Preprint CMS-10227 SPA PACE PREPRINT Redlined version (2020 version 3).rtf 05/18/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.