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GenIC #66 (Extension from MACPro): Eligibility Processing Data Report and Renewal Compliance Template

IC 271239 under ICR 202409-0938-028 · OMB 0938-1148.

Documents and Forms
Document Name
Document Type
Other-Data Specifications
Other-Data Specifications
Instruction
Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

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GenIC #66 (Extension from MACPro): Eligibility Processing Data Report and Renewal Compliance Template
 
New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Data Specifications Eligbility-Processing-Data-Specs-July-2024.pdf Yes Yes Printable Only
Form and Instruction GenIC #66 Compliance Assessment and Plan for Federal Medicaid and CHIP Renewal Requirements Template Compliance Template (2024 version 1).pdf Yes Yes Fillable Fileable
Instruction sho24002.pdf Yes No Printable Only
Form and Instruction GenIC #66 Eligibility Processing Data Report portal screen shots Medicaid and CHIP Eligibility Process Data Portal.pdf Yes Yes Fillable Fileable
Form and Instruction GenIC #66 Eligibility Processing Data Report excel workbook unwinding-data-rprt .pdf Yes Yes Fillable Fileable

Health Health Care Services

 

56 0
   
State, Local, and Tribal Governments
 
   100 %

  Requested 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 1,400 0 1,400 0 0 0
Annual IC Time Burden (Hours) 21,056 0 21,056 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Generic Supporting Statement GenIC 66_Generic Supporting Statement_(2024 version 11 Combined SL and BN).docx 09/27/2024
Public Comment lzj-v3ej-219z - Comment.pdf 09/27/2024
Response to Public Comment Response to Public Comments (Compliance Template) v2.docx 09/27/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.