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Periodic Renewal of Medicaid and CHIP Eligibility - Eligibility Notice (sections 435.916, 457.343, and 457.350)

IC 199157 under ICR 202512-0938-003 · OMB 0938-1147.

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Periodic Renewal of Medicaid and CHIP Eligibility - Eligibility Notice (sections 435.916, 457.343, and 457.350)
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 457.343 and 457.350 42 CFR 435.916

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability

Health Health Care Services

 

96 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 96 0 0 0 0 96
Annual IC Time Burden (Hours) 1,536 0 0 0 0 1,536
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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