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Federal forms, ICRs, and supporting documents

OMB control number

Model Application Template for State Child Health Plan Under Title XXI of the Social Security Act, State Children's Health Insurance Program, & Model Application Template & Instructions (CMS-R-211)

OMB 0938-0707 · HHS/CMS.

OMB 0938-0707

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form CMS-R-211 Model Application Template for State Child Health Plan Under Title XXI of the Social Security Act, State Children's Health Insurance Program, & Model Application Template & InstructionsForm and Instruction
Summary of revisions to Supporting Statement [rev 09-23-2012].docx Justification for No Material/Nonsubstantive Change
Crosswalk of nonsub template changes for CMS-R-211.doc Supplementary Document
CMS-R-211 Supporting Statement Resub Rev 09-19-12.docSupporting Statement A
Model Application Template for State Child Health Plan Under Title XXI of the Social Security Act, State Children's Health Insurance Program, & Model Application Template & Instructions Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
201209-0938-006 No material or nonsubstantive change to a currently approved collection 2012-09-24 Approved without change
201105-0938-014 Revision of a currently approved collection 2011-05-26 Approved without change
200805-0938-010 Extension without change of a currently approved collection 2008-05-27 Approved without change
200503-0938-007 Extension without change of a currently approved collection 2005-03-15 Approved without change
200203-0938-001 Revision of a currently approved collection 2002-03-08 Approved with change
200006-0938-005 Extension without change of a currently approved collection 2000-06-09 Approved without change
199804-0938-009 Reinstatement with change of a previously approved collection 1998-04-28 Approved without change
199709-0938-005 New collection (Request for a new OMB Control Number) 1997-09-08 Approved without change