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[Medicaid] GenIC #34 (Revised): Model Application Template and Instructions for State Child Health Plan Under Title XXI of the Social Security Act, State Children's Health Insurance Program CMCS
 
New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10398 #34 Title XXI State Plan Template 34 - Draft title-xxi-state-plan-template Childrens Vaccine Assurances FINAL (CLEAN)8-10-23.pdf Yes Yes Fillable Fileable
Other-Track Change: Title XXI State Plan Template Draft title-xxi-state-plan-template Childrens Vaccine Assurances FINAL (REDLINE).docx No   Printable Only

Health Health Care Services

 

40 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 40 0 40 0 0 0
Annual IC Time Burden (Hours) 160 0 160 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Generic Supporting Statement GenIC # 34 - Generic Supporting Statement (2023 version 5).docx 09/22/2023
State Health Official (SHO) Letter # 23-003 Vaccine SHO #23-003.pdf 09/22/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.