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Report of Medicaid State Office on Beneficiary's Buy-In Status

IC 33999 under ICR 202311-3220-003 · OMB 3220-0185.

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Report of Medicaid State Office on Beneficiary's Buy-In Status
 
No Modified
 
Mandatory
 
42 CFR 407

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form RL-380-F (05-18) Report of Medical State Office on Beneficiary's Buy-In Status Form RL-380-F (05-18).pdf No   Paper Only
Form RL-380-F (Proposed) Report of Medical Beneficiary's Buy-In Status Form RL-380-F (XX-XX).pdf No   Paper Only

Income Security General Retirement and Disability

RRB-20; Health Insurance and Supplementary Medical Insurance Enrollment and Premium Payment System   79 FR 58874

600 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 600 0 0 0 0 600
Annual IC Time Burden (Hours) 100 0 0 0 0 100
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Report of State Buy-In Problem CMS-1957 (04-18).pdf 06/16/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.