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GenIC #69 (Nonsubstantive Change): Reporting Requirements for Additional Funding for Medicaid HCBS During the COVID–19 Emergency
[Medicaid] Generic Clearance for Medicaid and CHIP State Plan, Waiver, and Program Submissions (CMS-10398)
OMB: 0938-1148
IC ID: 247999
OMB.report
HHS/CMS
OMB 0938-1148
ICR 202401-0938-016
IC 247999
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1148 can be found here:
2024-09-27 - Reinstatement with change of a previously approved collection
2024-07-11 - Reinstatement without change of a previously approved collection
Documents and Forms
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 5).docx
Generic Supporting Statement
IC Document
GenIC #69 - Generic Supporting Statement (2021 version 5).docx
Generic Supporting Statement
IC Document
kph-dyqa-xgul - Combined Cover and Comment.pdf
Public Comment
IC Document
kph-dyqa-xgul - Combined Cover and Comment.pdf
Public Comment
IC Document
ARP PRA Public Comment Response_6.16.20.docx
Response to Public Comment
IC Document
ARP PRA Public Comment Response_6.16.20.docx
Response to Public Comment
IC Document
Justification for Nonsubstantive Change.docx
Justification for Nonsubstantive Change
IC Document
Justification for Nonsubstantive Change.docx
Justification for Nonsubstantive Change
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
GenIC #69 (Nonsubstantive Change): 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:
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
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:
56
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
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
616
0
0
0
0
616
Annual IC Time Burden (Hours)
5
0
0
0
0
5
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Generic Supporting Statement
GenIC #69 - Generic Supporting Statement (2021 version 5).docx
06/22/2021
Public Comment
kph-dyqa-xgul - Combined Cover and Comment.pdf
06/22/2021
Response to Public Comment
ARP PRA Public Comment Response_6.16.20.docx
06/22/2021
Justification for Nonsubstantive Change
Justification for Nonsubstantive Change.docx
06/22/2021
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.