Information Collection

CHIPRA Connecting Kids to Coverage Outreach and Enrollment Grants (CMS-10398; GenIC #7)

IC 254145 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⚠️ Notice: This information collection may be referencing outdated material.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
Form CMS-10398 (GenIC#7 CHIPRA Connecting Kids to Coverage Outreach and Enrollment Grants (CMS-10398; GenIC #7)	Form and Instruction
Form CMS-10398 (GenIC#7 CHIPRA Connecting Kids to Coverage Outreach and Enrollment Grants (CMS-10398; GenIC #7)	Form and Instruction
CMS-10398 (GenIC#7 CMS-10398_GenIC_7-CycleVaSAR508 CMS-10398_GenIC_7-CycleVaSAR508.pdf	Form and Instruction
CMS-10398 (GenIC#7 CMS-10398_GenIC_7-CycleVaSAR508 CMS-10398_GenIC_7-CycleVaSAR508.pdf	Form and Instruction
CMS-10398 (GenIC#7 CMS-10398_GenIC_7-CycleVbFinalSAR508 CMS-10398_GenIC_7-CycleVbFinalSAR508.pdf	Form and Instruction
CMS-10398 (GenIC#7 CMS-10398_GenIC_7-CycleVbFinalSAR508 CMS-10398_GenIC_7-CycleVbFinalSAR508.pdf	Form and Instruction
CMS-10398 (GenIC#7 CMS-10398_GenIC_7-CycleVbMonthlyReport508 CMS-10398_GenIC_7-CycleVbMonthlyReport508.pdf	Form and Instruction
CMS-10398 (GenIC#7 CMS-10398_GenIC_7-CycleVbMonthlyReport508 CMS-10398_GenIC_7-CycleVbMonthlyReport508.pdf	Form and Instruction
CMS-10398 (GenIC#7 CMS-10398_GenIC_7-CycleVbMonthlyReportwAIANTarget CMS-10398_GenIC_7-CycleVbMonthlyReportwAIANTarget.pdf	Form and Instruction
CMS-10398 (GenIC#7 CMS-10398_GenIC_7-CycleVbMonthlyReportwAIANTarget CMS-10398_GenIC_7-CycleVbMonthlyReportwAIANTarget.pdf	Form and Instruction
CMS-10398 (GenIC#7 CMS-10398_GenIC_7-CycleVbMonthlyReportwTarget CMS-10398_GenIC_7-CycleVbMonthlyReportwTarget.pdf	Form and Instruction
CMS-10398 (GenIC#7 CMS-10398_GenIC_7-CycleVbMonthlyReportwTarget CMS-10398_GenIC_7-CycleVbMonthlyReportwTarget.pdf	Form and Instruction
CMS-10398_GenIC_7-SupportingStatement.docx CMS-10398_GenIC_7-SupportingStatement	IC Document
CMS-10398_GenIC_7-SupportingStatement.docx CMS-10398_GenIC_7-SupportingStatement	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

CHIPRA Connecting Kids to Coverage Outreach and Enrollment Grants (CMS-10398; GenIC #7)

Agency IC Tracking Number:

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10398 (GenIC#7)	CMS-10398_GenIC_7-CycleVaSAR508	CMS-10398_GenIC_7-CycleVaSAR508.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10398 (GenIC#7)	CMS-10398_GenIC_7-CycleVbFinalSAR508	CMS-10398_GenIC_7-CycleVbFinalSAR508.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10398 (GenIC#7)	CMS-10398_GenIC_7-CycleVbMonthlyReport508	CMS-10398_GenIC_7-CycleVbMonthlyReport508.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10398 (GenIC#7)	CMS-10398_GenIC_7-CycleVbMonthlyReportwAIANTarget	CMS-10398_GenIC_7-CycleVbMonthlyReportwAIANTarget.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10398 (GenIC#7)	CMS-10398_GenIC_7-CycleVbMonthlyReportwTarget	CMS-10398_GenIC_7-CycleVbMonthlyReportwTarget.pdf	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: 47

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	1,973	1,973
Annual IC Time Burden (Hours)	10,102	10,102
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS-10398_GenIC_7-SupportingStatement	CMS-10398_GenIC_7-SupportingStatement.docx	06/09/2022

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