View Information Collection (IC)

View Information Collection (IC)

Medicaid Premiums and Cost Sharing (#29)
 
New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10398 (#29) Medicaid Premiums and Cost Sharing Copy of Medicaid Cost Sharing_FINAL_2-3-14_clean2.pdf Yes Yes Fillable Printable
Instruction IG_G1-Cost Sharing Requirements_Draft_MMDL_2-3-14(final clean).pdf Yes No Printable Only
Instruction IG_G2a_Cost Sharing Amounts-CN_Draft_MMDL_2-3-14(final clean).pdf Yes No Printable Only
Instruction IG_G2b_Cost Sharing Amounts-MN_Draft_MMDL_2-3-14(final clean).pdf Yes No Printable Only
Instruction IG_G2c-Cost Sharing Amounts-Targeting_Draft_2-3-14(final clean) (4).pdf Yes No Printable Only
Instruction IG_G3-Cost Sharing Limitations_Draft_MMDL_2-3-14(final clean) (3).pdf Yes No Printable Only

Health Health Care Services

 

10 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 10 0 0 0 0 0
Annual IC Time Burden (Hours) 50 0 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS-10398 (#29) Supporting Statement CMS-R-53 - Generic Supporting Statement [rev 3-18-2014 by OSORA PRA].docx 03/18/2014
Crosswalk Cost Sharing Crosswalk 1 16 14 rys rb.pdf 03/18/2014
Summary of Comments/CMS Response CMS R-53 Response to Comments to OMB (v2).doc 03/18/2014
NHeLP_Comments_to_CMS-R-53_Cost-Sharing_Preprint NHeLP_Comments_to_CMS-R-53_Cost-Sharing_Preprint.pdf 03/18/2014
FINAL-TTAG_comments_CMS-R-53_CMS-10398_2014-03-17d FINAL-TTAG_comments_CMS-R-53_CMS-10398_2014-03-17d.pdf 03/18/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.