View Information Collection (IC)

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GenIC #77 (Revision): Medicaid Extended Postpartum Coverage and Continuous Eligibility for Children CMCS
 
New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10434 #77 Home Page and Initial Application Forms Home Page and Initial Application Form.pdf Yes Yes Fillable Fileable
Form CMS-10434 #77 Continuous Eligibility for Pregnant Women and Extended Postpartum Coverage Continuous Eligibility for Pregnant Women and Postpartum Woman.pdf Yes Yes Fillable Fileable
Form CMS-10434 #77 Continuous Eligibility for Children (Revised SPA Template) Childrens Continuous Eligibility CLEAN.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

56 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved 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 75 0 75 0 0 0
Annual IC Time Burden (Hours) 5 0 5 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Generic Supporting Statement GenIC #77 - Generic Supporting Statement (2023 version 7).docx 11/15/2023
Track Change: Continuous Eligibility for Children SPA Template Children Continuous Eligibility Track Changes.docx 11/15/2023
Crosswalk: Continuous Eligibility for Children SPA Template Childrens Continuous Eligibility Crosswalk.pdf 11/15/2023
SHO letter 23-004 sho23004.pdf 11/15/2023
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