Income and Eligibility Verification System Reporting and Supporting Regs. (CMS-R-74)

OMB 0938-0467

This collection is necessary to verify income and eligibility requirements for Medicaid recipients, as required by Section 1137 of the Social Security Act.

The latest form for Income and Eligibility Verification System Reporting and Supporting Regs. (CMS-R-74) expires 2022-04-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-R-74 Income and Eligibility Verification System Reporting and Supporting Regs. Form
CMS-R- 74 - Supportng Statement A (2022 version 3).docx Supporting Statement A
Income and Eligibility Verification System Reporting and Supporting Regs. Form

All Historical Document Collections

202204-0938-011 Approved without change	Extension without change of a currently approved collection	2022-04-29
201901-0938-001 Approved without change	Extension without change of a currently approved collection	2019-01-29
201506-0938-014 Approved with change	Extension without change of a currently approved collection	2015-06-29
201203-0938-013 Approved without change	Revision of a currently approved collection	2012-03-28
200903-0938-001 Approved without change	Extension without change of a currently approved collection	2009-03-10
200601-0938-007 Approved without change	Extension without change of a currently approved collection	2006-01-17
200207-0938-011 Approved without change	Extension without change of a currently approved collection	2002-07-30
199909-0938-012 Approved without change	No material or nonsubstantive change to a currently approved collection	1999-09-30
199903-0938-003 Approved without change	Extension without change of a currently approved collection	1999-03-16
199602-0938-008 Approved without change	Reinstatement without change of a previously approved collection	1996-02-16
199207-0938-012 Approved without change	Reinstatement with change of a previously approved collection	1992-07-31
198904-0938-009 Approved without change	Revision of a currently approved collection	1989-04-06
198602-0938-004 Approved without change	New collection (Request for a new OMB Control Number)	1986-02-28