Information Collection

GenIC #7 (Revision): Connecting Kids to Coverage Outreach and Enrollment

IC 256905 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⚠️ Notice: This information collection may be referencing outdated material.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 #7 GenIC #7 (Revision): Connecting Kids to Coverage Outreach and Enrollment	Form
Form CMS-10398 #7 GenIC #7 (Revision): Connecting Kids to Coverage Outreach and Enrollment	Form
CMS-10398 #7 Semi-Annual Report Template ATTACHMENT 1-Semi-Annual Report Template508.pdf	Form
CMS-10398 #7 Semi-Annual Report Template ATTACHMENT 1-Semi-Annual Report Template508.pdf	Form
CMS-10398 #7 Final Report Template ATTACHMENT 2-Final Report Template508.pdf	Form
CMS-10398 #7 Final Report Template ATTACHMENT 2-Final Report Template508.pdf	Form
CMS-10398 #7 HK2019 and HK2020 Monthly Progress Report Template ATTACHMENT 3-HK2019 and HK2020 Monthly Progress Report Template508.pdf	Form
CMS-10398 #7 HK2019 and HK2020 Monthly Progress Report Template ATTACHMENT 3-HK2019 and HK2020 Monthly Progress Report Template508.pdf	Form
CMS-10398 #7 HK2019 Monthly Progress Report with Targets Template ATTACHMENT 4-Monthly Progress Report with Targets.pdf	Form
CMS-10398 #7 HK2019 Monthly Progress Report with Targets Template ATTACHMENT 4-Monthly Progress Report with Targets.pdf	Form
CMS-10398 #7 HK2022 and HK2023 Monthly Progress Report Template ATTACHMENT 5-HK2022 and HK2023 Monthly Progress Report Template.pdf	Form
CMS-10398 #7 HK2022 and HK2023 Monthly Progress Report Template ATTACHMENT 5-HK2022 and HK2023 Monthly Progress Report Template.pdf	Form
GenIC_7-Generic SupportingStatement_(2022 version 14).docx Generic Supporting Statement	IC Document
GenIC_7-Generic SupportingStatement_(2022 version 14).docx Generic Supporting Statement	IC Document
Track Change - Attachment 5 - HK2022 and HK2023 Monthly Progress Report Template.pdf Track Change - HK2022 and HK2023 Monthly Progress Report Template	IC Document
Track Change - Attachment 5 - HK2022 and HK2023 Monthly Progress Report Template.pdf Track Change - HK2022 and HK2023 Monthly Progress Report Template	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

GenIC #7 (Revision): Connecting Kids to Coverage Outreach and Enrollment

Agency IC Tracking Number:

CMCS

IC Status: Unchanged

Obligation to Respond: Voluntary

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	CMS-10398 #7	Semi-Annual Report Template	ATTACHMENT 1-Semi-Annual Report Template508.pdf	Yes	Yes	Fillable Fileable
Form	CMS-10398 #7	Final Report Template	ATTACHMENT 2-Final Report Template508.pdf	Yes	Yes	Fillable Fileable
Form	CMS-10398 #7	HK2019 and HK2020 Monthly Progress Report Template	ATTACHMENT 3-HK2019 and HK2020 Monthly Progress Report Template508.pdf	Yes	Yes	Fillable Fileable
Form	CMS-10398 #7	HK2019 Monthly Progress Report with Targets Template	ATTACHMENT 4-Monthly Progress Report with Targets.pdf	Yes	Yes	Fillable Fileable
Form	CMS-10398 #7	HK2022 and HK2023 Monthly Progress Report Template	ATTACHMENT 5-HK2022 and HK2023 Monthly Progress Report Template.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: 91

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	1,365	1,365
Annual IC Time Burden (Hours)	7,826	7,826
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Supporting Statement	GenIC_7-Generic SupportingStatement_(2022 version 14).docx	12/13/2022
Track Change - HK2022 and HK2023 Monthly Progress Report Template	Track Change - Attachment 5 - HK2022 and HK2023 Monthly Progress Report Template.pdf	12/13/2022

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