Information Collection

GenIC #69 (New): Reporting Requirements for Additional Funding for Medicaid HCBS During the COVID-19 Emergency

IC 247050 under ICR 202401-0938-016 · OMB 0938-1148.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1148 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
00451257 SMD ARP FMAP HCBS - EOP clean 5.10 6pm.docx	Other-SMDL
00451257 SMD ARP FMAP HCBS - EOP clean 5.10 6pm.docx	Other-SMDL
GenIC #69 - Generic Supporting Statement (2021 version 4).docx Generic Supporting Statement	IC Document
GenIC #69 - Generic Supporting Statement (2021 version 4).docx Generic Supporting Statement	IC Document

IC Title:

GenIC #69 (New): Reporting Requirements for Additional Funding for Medicaid HCBS During the COVID-19 Emergency

Agency IC Tracking Number:

CMCS

IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation:

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
Other-SMDL			00451257 SMD ARP FMAP HCBS - EOP clean 5.10 6pm.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 56

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	616	616
Annual IC Time Burden (Hours)	1,344	1,344
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Supporting Statement	GenIC #69 - Generic Supporting Statement (2021 version 4).docx	05/11/2021

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