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CHIPRA 214 Option (§§ 435.4 and 457.320(c))
Medicaid Program; Eligibility Changes under the Affordable Care Act of 2010 (CMS-10410)
OMB: 0938-1147
IC ID: 261062
OMB.report
HHS/CMS
OMB 0938-1147
ICR 202306-0938-010
IC 261062
( )
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
CHIPRA 214 Option (§§ 435.4 and 457.320(c))
Agency IC Tracking Number:
CMCS
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
42 CFR 435.4
42 CFR 457.320(c)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
39
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
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
4,101
0
4,101
0
0
0
Annual IC Time Burden (Hours)
4,101
0
4,101
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.