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GenIC #33 (Extension w/o change): Opportunity for families of Disabled Children to Purchase Medicaid Coverage for Such Children (DRA 6062)
 
New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10398 #33 FOA Preprint 33 - Preprint - DRA 6062 (_33) [rev 7-17-2014 by OSORA PRA].docx Yes Yes Fillable Fileable

Health Health Care Services

 

40 0
   
State, Local, and Tribal Governments
 
   100 %

  Requested 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 40 0 40 0 0 0
Annual IC Time Burden (Hours) 3,200 0 3,200 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
#33 - Supporting Statement 33 - Revised Supporting Statement DRA 6062.docx 01/09/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.