GenIC #71 (New): Reporting Requirements for State Planning Grants for Qualifying Community-Based Mobile Crisis Intervention Services During the COVID–19 Emergency

[Medicaid] Generic Clearance for Medicaid and CHIP State Plan, Waiver, and Program Submissions (CMS-10398)

71 - F5 Reporting PRA

GenIC #71 (New): Reporting Requirements for State Planning Grants for Qualifying Community-Based Mobile Crisis Intervention Services During the COVID–19 Emergency

OMB: 0938-1148

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F5. Reporting
a. Progress Reports
Each recipient will be required to submit quarterly progress reports and a final progress report. These reports should include narrative
updates on planning grant activities as well as information on each recipient’s approved work plan as specified in each recipient’s
approved application in accordance with the Section 9813 State Planning Grants for Qualifying Community-Based Mobile Crisis
Intervention Services.
PRA Disclosure Statement The purpose of the PRA Package is to identify the mandatory collection and associated burden of the
American Rescue Plan Act (ARP) of 2021: Section 9813 State Planning Grants for Qualifying Community-Based Mobile Crisis
Intervention Services quarterly and final progress reports. Under the Privacy Act of 1974 any personally identifying information
obtained will be kept private to the extent of the law.
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it
displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1148 (CMS-10398
#71). The time required to complete this information collection is estimated to average four hours per response, including the time
to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.
If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to:
CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.


File Typeapplication/pdf
File Title69 - F5 Reporting PRA
AuthorEffie George
File Modified2021-05-11
File Created2021-05-06

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