Information Collection

Reporting - State Mandates

IC 241291 under ICR 202003-0938-018 · OMB 0938-1174.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1174 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10448 Reporting - State Mandates Form and Instruction
CMS-10448 State Annual Report CMS-10448 - Appendix G - State Annual Reports.pdf Form and Instruction
CMS-10448 State Certification Annual Report (SBRs) CMS-10448 - Appendix H - State Cert AnnlRpt SRBs.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Reporting - State Mandates	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 156.111

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10448	State Annual Report	CMS-10448 - Appendix G - State Annual Reports.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10448	State Certification Annual Report (SBRs)	CMS-10448 - Appendix H - State Cert AnnlRpt SRBs.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 41	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	41	41
Annual IC Time Burden (Hours)	1,763	1,763
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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