OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Administrative Requirements for Section 6071 of the DRA

IC 186838 under ICR 202402-0938-007 · OMB 0938-1053.

Documents and Forms
Document Name
Document Type
Form
Instruction
Instruction
Other-Operational Protocol
Other-Operational Protocol
Instruction
Instruction
Other-Portal Screenshot
Other-Portal Screenshot
Other-Portal Screenshot
Other-Portal Screenshot
Other-Portal Screenshot
Other-Portal Screenshot
Other-Portal Screenshot
Form
Form
Form
Form
Form
Form
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form
Form
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Administrative Requirements for Section 6071 of the DRA
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10249 Semi-Annual Progress Report MFP-Semi-Annual-Report.pdf Yes Yes Fillable Fileable
Form CMS-10249 MFP Financial Reporting Forms ABCD MFP_Financial_Reporting_FormsABCD.pdf Yes Yes Fillable Printable
Instruction MFP-Semi-Annual-Rprt-Help-File.pdf Yes Yes Fillable Printable
Form CMS-64.9i, -64.9pi, -64.10i, and -64.910pi, Quarterly Expenditures CMS 64i Expenditure Forms.pdf Yes No Fillable Printable
Form and Instruction CMS-10249 MFP_Budget_Workbook MFP_Budget_Workbook.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10249 Maintenance of Effort (MOE) Form MFP_MOE_Form.pdf Yes Yes Fillable Fileable
Other-Operational Protocol MFP-Operational-Protocol.pdf Yes Yes Printable Only
Form CMS-10249 Work Plan MFP-Work-Plan.pdf Yes Yes Fillable Fileable
Instruction MFP-Work-Plan-Help-File.pdf Yes No Printable Only
Other-Portal Screenshot State SAR experience.pdf Yes Yes Fillable Fileable
Other-Portal Screenshot Admin SAR experience.pdf Yes Yes Fillable Fileable
Other-Portal Screenshot Admin WP experience.pdf Yes Yes Fillable Fileable
Other-Portal Screenshot State WP experience.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

41 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved 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 410 0 74 0 0 336
Annual IC Time Burden (Hours) 5,003 0 2,399 0 0 2,604
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk: Semi-Annual Report MFP-SAR-Crosswalk.pdf 02/23/2024
Crosswalk: Semi Annual Report Help MFP-SAR-Help-File-Crosswalk.pdf 02/23/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.