GenIC #72 (Nonsubstantive Change): Expressions of Interest in the Infant Well-Child Visit Affinity Group

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

OMB: 0938-1148

IC ID: 249074

Information Collection (IC) Details

View Information Collection (IC)

GenIC #72 (Nonsubstantive Change): Expressions of Interest in the Infant Well-Child Visit Affinity Group CMCS
 
Unchanged
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10398 #72 Expression of Interest Form well-child-visit-ag-interest-form.pdf Yes Yes Fillable Fileable
Other-Affinity Group Fact Sheet well-child-visit-ag-fact-sheet.pdf No   Printable Only

Health Health Care Services

 

20 0
   
State, Local, and Tribal Governments
 
   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 20 0 0 0 0 20
Annual IC Time Burden (Hours) 5 0 0 0 0 5
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Generic Supporting Statement GenIC 72 - Generic Supporting Statement (2021 version 7).docx 08/27/2021
Justification for Nonsubstantive Change Justification for Nonsubstantive Change.docx 08/27/2021
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