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Federal forms, ICRs, and supporting documents

OMB control number

[Medicaid] Generic Clearance for Medicaid and CHIP State Plan, Waiver, and Program Submissions (CMS-10398)

OMB 0938-1148 · HHS/CMS.

OMB 0938-1148

The Center for Medicaid, CHIP, and Survey & Certification in CMS works in partnership with States to implement Medicaid and the Children's Health Insurance Program (CHIP), and the Social Security Act requires written plans between CMS and the State to implement these programs. The Affordable Care Act enacted comprehensive reform that requires modification of existing programs. In addition to the Medicaid and CHIP State plans, CMS also continues to work with States through other methods to further the goals of health reform, including program waivers and demonstrations and other technical assistance initiatives and reporting. This collection will provide streamlined submission forms for States to implement health reform initiatives in Medicaid and CHIP state plans, demonstrations, and waivers, including legislative requirements enacted by the Affordable Care Act.

The latest form for [Medicaid] Generic Clearance for Medicaid and CHIP State Plan, Waiver, and Program Submissions (CMS-10398) expires 2029-08-31 and is listed under ICR 202607-0938-014.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form GenIC #66 Unwinding Eligibility and Enrollment Data Reporting TemplateForm and Instruction
Form GenIC #66 Unwinding Eligibility and Enrollment Data Reporting TemplateForm and Instruction
Form GenIC #66 Data portalForm and Instruction
Form GenIC #66 Data portalForm and Instruction
Form GenIC #66 Eligibility Processing Reports Portal Screen ShotsForm and Instruction
Form GenIC #66 Eligibility Processing Reports Portal Screen ShotsForm and Instruction
Form GenIC #35 Eligibility and Enrollment Performance Indicators TemplateForm and Instruction
Form GenIC #35 Eligibility and Enrollment Performance Indicators TemplateForm and Instruction
Form GenIC #11 MAGI Verification Plan Supplement: Community Engagement Guidance and TemplateForm and Instruction
Form GenIC #11 MAGI Verification Plan Supplement: Community Engagement Guidance and TemplateForm and Instruction
Form GenIC #11 Disaster Relief MAGI-Based Verification Plan AddendumForm and Instruction
Form GenIC #11 Disaster Relief MAGI-Based Verification Plan AddendumForm and Instruction
Form GenIC #11 MAGI-Based Eligibility Verification Plan TemplateForm and Instruction
Form GenIC #11 MAGI-Based Eligibility Verification Plan TemplateForm and Instruction
Form See NOA GenICs Active as of 7-29-2026Form and Instruction
Form See NOA GenICs Active as of 7-29-2026Form and Instruction
CMS-10398 - Supporting Statement A (2026 version 5).docxSupporting Statement A
CMS-10398 - Supporting Statement A (2026 version 5).docxSupporting Statement A
GenIC #101 New (Medicaid Community Engagement: Short-term Hardship Exception Requests) Information collection
GenIC #100 New (Medicaid Community Engagement: Good Faith Effort Exemptions and Quarterly Reporting) Information collection
GenIC #66 Revised (Eligibility Processing Data Report) Form and Instruction
GenIC #66 Revised (Eligibility Processing Data Report) Form and Instruction
GenIC #66 Revised (Eligibility Processing Data Report) Form and Instruction
GenIC #66 Revised (Eligibility Processing Data Report) Form and Instruction
GenIC #66 Revised (Eligibility Processing Data Report) Form and Instruction
GenIC #66 Revised (Eligibility Processing Data Report) Form and Instruction
GenIC #66 Revised (Eligibility Processing Data Report) Other-Eligibility Processing Data Report Specifications
GenIC #35 Revised (Eligibility and Enrollment Performance Indicators) Form and Instruction
GenIC #35 Revised (Eligibility and Enrollment Performance Indicators) Form and Instruction
GenIC #35 Revised (Eligibility and Enrollment Performance Indicators) Other-Performance Indicators Data Dictionary
GenIC #11 Revised (MAGI-Based Eligibility Verification Plan) Form and Instruction
GenIC #11 Revised (MAGI-Based Eligibility Verification Plan) Form and Instruction
GenIC #11 Revised (MAGI-Based Eligibility Verification Plan) Form and Instruction
GenIC #11 Revised (MAGI-Based Eligibility Verification Plan) Form and Instruction
GenIC #11 Revised (MAGI-Based Eligibility Verification Plan) Form and Instruction
GenIC #11 Revised (MAGI-Based Eligibility Verification Plan) Form and Instruction
Active GenICs (NOA issued 07-29-2026) Form and Instruction
Active GenICs (NOA issued 07-29-2026) Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202607-0938-014 Revision of a currently approved collection 2026-07-30
202409-0938-028 Reinstatement with change of a previously approved collection 2024-09-27 Approved without change
202407-0938-005 Reinstatement without change of a previously approved collection 2024-07-11 Improperly submitted
202401-0938-016 No material or nonsubstantive change to a currently approved collection 2024-01-30 Approved without change
202103-0938-018 Revision of a currently approved collection 2021-03-23 Approved with change
201712-0938-019 Revision of a currently approved collection 2017-12-29 Approved with change
201410-0938-016 Revision of a currently approved collection 2014-10-30 Approved with change
201111-0938-009 No material or nonsubstantive change to a currently approved collection 2011-11-22 Approved without change
201109-0938-004 New collection (Request for a new OMB Control Number) 2011-09-19 Approved without change

OMB Details

Active GenICs (NOA issued 07-29-2026)

Federal Enterprise Architecture: Health - Health Care Services

Information collection instruments
FormNameElectronic accessType
Form See NOAGenICs Active as of 7-29-2026Fillable FileableForm and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.