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

Documents and forms in this information collection
Document NameDocument Type
Form CMS-10249
Administrative Requirements for Section 6071 of the DRA		 Form
MFP-Semi-Annual-Rprt-Help-File.pdf Instruction
MFP-Semi-Annual-Rprt-Help-File.pdf Instruction
MFP-Operational-Protocol.pdf Other-Operational Protocol
MFP-Operational-Protocol.pdf Other-Operational Protocol
MFP-Work-Plan-Help-File.pdf Instruction
MFP-Work-Plan-Help-File.pdf Instruction
Portal Screenshot 1_MFP_SAR_112123_r.pdf Other-Portal Screenshot
State SAR experience.pdf Other-Portal Screenshot
Portal Screenshot 1_MFP_SAR_Admin_Portal_112123_r.pdf Other-Portal Screenshot
Admin SAR experience.pdf Other-Portal Screenshot
Portal Screenshot 1_MFP_WorkPlan_Admin_11212023_r.pdf Other-Portal Screenshot
Admin WP experience.pdf Other-Portal Screenshot
State WP experience.pdf Other-Portal Screenshot
CMS-10249 Semi-Annual Progress Report
MFP-Semi-Annual-Report.pdf 		Form
CMS-10249 Semi-Annual Progress Report
MFP-Semi-Annual-Report.pdf 		Form
CMS-10249 MFP Financial Reporting Forms ABCD
MFP_Financial_Reporting_FormsABCD.pdf 		Form
CMS-10249 MFP Financial Reporting Forms ABCD
MFP_Financial_Reporting_FormsABCD.pdf 		Form
CMS-64.9i, -64.9pi Quarterly Expenditures
CMS 64i Expenditure Forms.pdf 		Form
CMS-64.9i, -64.9pi Quarterly Expenditures
CMS 64i Expenditure Forms.pdf 		Form
CMS-10249 MFP_Budget_Workbook
MFP_Budget_Workbook.pdf 		Form and Instruction
CMS-10249 MFP_Budget_Workbook
MFP_Budget_Workbook.pdf 		Form and Instruction
CMS-10249 Maintenance of Effort (MOE) Form
MFP_MOE_Form.pdf 		Form and Instruction
CMS-10249 Maintenance of Effort (MOE) Form
MFP_MOE_Form.pdf 		Form and Instruction
CMS-10249 Work Plan
MFP-Work-Plan.pdf 		Form
CMS-10249 Work Plan
MFP-Work-Plan.pdf 		Form
MFP-SAR-Crosswalk.pdf
Crosswalk: Semi-Annual Report		IC Document
MFP-SAR-Crosswalk.pdf
Crosswalk: Semi-Annual Report		IC Document
MFP-SAR-Help-File-Crosswalk.pdf
Crosswalk: Semi Annual Report Help		IC Document
MFP-SAR-Help-File-Crosswalk.pdf
Crosswalk: Semi Annual Report Help		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

Information Collection Instruments:
table that charts list of instruments
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

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  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

Documents for IC
table that charts IC Documents
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.