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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
GenIC #66 (New): Medicaid and CHIP COVID 19 Public Health Emergency Unwinding Reports
Agency IC Tracking Number:
CMCS
IC Status:
Unchanged
Obligation to Respond:
Mandatory
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
CMS-10398 #66
Screenshots: Unwinding Data Report
#66 - Unwinding Data Report screen shots (2022 version 1).pdf
Yes
Yes
Fillable Fileable
Other-Unwinding Data Report Specifications
#66 - Unwinding Data Report specifications (2022 version 4).pdf
Yes
Yes
Fillable Fileable
Form
CMS-10398 # 66
Unwinding Data Report Workbook
#66 Unwinding Data Report excel workbook (2022 version 3).xlsx
Yes
Yes
Fillable Fileable
Form and Instruction
CMS-10398 #66
State Renewals Report
#66 State Renewals Report (2022 version 3).docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
56
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
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
896
0
0
0
0
896
Annual IC Time Burden (Hours)
14,224
0
0
0
0
14,224
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
SHO letter 21002 August 2021
SHO Letter 21002 August 2021.pdf
02/28/2022
Placeholder: SHO letter 2200X March 2022
Placeholder - SHO Letter 2200X March 2022.docx
02/28/2022
Generic Supporting Statement
#66 - Generic Supporting Statement (2022 version 6).docx
02/28/2022
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.