Information Collection

GenIC #11 Revised (MAGI-Based Eligibility Verification Plan)

IC 281673 under ICR 202607-0938-014 · OMB 0938-1148.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form GenIC #11 MAGI-Based Eligibility Verification Plan Template GenIC #11 Revised (MAGI-Based Eligibility Verification Plan)	Form and Instruction
Form GenIC #11 Disaster Relief MAGI-Based Verification Plan Addendum GenIC #11 Revised (MAGI-Based Eligibility Verification Plan)	Form and Instruction
Form GenIC #11 MAGI Verification Plan Supplement: Community Engagement Guidance and Template GenIC #11 Revised (MAGI-Based Eligibility Verification Plan)	Form and Instruction
GenIC #11 MAGI-Based Eligibility Verification Plan Template Eligibility Verification_Plan_Template (3-31-2020).docx	Form and Instruction
GenIC #11 Disaster Relief MAGI-Based Verification Plan Addendum CMS-10398#11. MAGI-Based Eligibility Verification Plan Attachment Disaster Ver Plan Addendum FINAL (3-31-20) (1).docx	Form and Instruction
GenIC #11 MAGI Verification Plan Supplement: Community Engagement CE Verification Plan Supplement (revised 05-12-2026).docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	GenIC #11	Yes	Yes	Fillable Fileable
Form and Instruction	GenIC #11	Yes	Yes	Fillable Fileable
Form and Instruction	GenIC #11	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 56

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	156	156
Annual IC Time Burden (Hours)	5,520	5,520
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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