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#75 (New): ARP 1135 State Plan Amendment

IC 251150 under ICR 202401-0938-016 · OMB 0938-1148.

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#75 (New): ARP 1135 State Plan Amendment CMCS
 
Unchanged
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form cms-10398 #75 Preprint Attachment 7.7A: Vaccine and Vaccine Administration Preprint Attachment 7.7A (2022 version 3).docx Yes Yes Fillable Fileable
Form cms-10398 #75 Preprint Attachment 7.7B: COVID-19 Testing Preprint Attachment 7.7B (2022 version 3).docx Yes Yes Fillable Fileable
Form cms-10398 #75 Preprint Attachment 7.7C: COVID-19 Treatment Preprint Attachment 7.7C (2022 version 3).docx Yes Yes Fillable Fileable
Form CMS-10398 #75 Template for Medicaid Section 1135 Waiver of SPA Submission Requirements Template 1135 Waiver (2022 version 2).docx Yes Yes Fillable Fileable

Health Health Care Services

 

56 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 56 0 0 0 0 56
Annual IC Time Burden (Hours) 168 0 0 0 0 168
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Generic Supporting Statement GenIC 75 - Generic Supporting Statement (2022 version 5).docx 01/31/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.