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)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
71 - F5 Reporting PRA.pdf Instruction
71 - F5 Reporting PRA.pdf Instruction
71 - Supporting Statement ARP (2021 version 8).docx GenIC #71 - Generic Supporting Statement IC Document
71 - Supporting Statement ARP (2021 version 8).docx GenIC #71 - Generic Supporting Statement IC Document

Information Collection (IC) Details

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

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			71 - F5 Reporting PRA.pdf		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	160	160
Annual IC Time Burden (Hours)	640	640
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
GenIC #71 - Generic Supporting Statement	71 - Supporting Statement ARP (2021 version 8).docx	06/02/2021

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