Information Collection

Reporting - State Mandates

IC 241291 under ICR 202006-0938-008 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10448 Reporting - State Mandates	Form and Instruction
CMS-10448 State Annual Report AppG-Annual-Report-SRBs-508.pdf	Form and Instruction
CMS-10448 State Certification Annual Report (SBRs) AppH-StateCert-AnnlRpt-SRB-508.pdf	Form and Instruction

IC Title:

Reporting - State Mandates

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 156.111

Information Collection Instruments:

table that charts list of 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	AppG-Annual-Report-SRBs-508.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10448	State Certification Annual Report (SBRs)	AppH-StateCert-AnnlRpt-SRB-508.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 %

table that charts list of burden
	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

table that charts IC Documents
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.