[Medicaid] State Collection and Reporting of Dental Provider and Benefit Package Information on the Insure Kids Now! Website and Hotline (CMS-10291)

ICR 202404-0938-021

OMB: 0938-1065

Federal Form Document

Forms and Documents

Document Name	Status
Form CMS-10291 Collection of Dental Benefit Information Form	Unchanged
Form CMS-10291 Collection of Dental Provider Information Form and Instruction	Modified
CMS-10291 - Supporting Statement A (2024 version 5).docx Supporting Statement A	2024-04-25

IC Document Collections

IC ID	Document Title	Status
189779	Collection of Dental Benefit Information Form	Unchanged
189778	Collection of Dental Provider Information Form and Instruction	Modified