Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
GenIC #3 - Alternative Benefit Plans (ABPs) Unchanged 56 728 0 Form CMS-10434 (#3)
GenIC # 45 (Transfer from 0938-1148): Maternal and Infant Health Quality New 112 112 0 Form CMS-10434 #45
Form CMS-10434 #45
GenIC #1 - Initial Application Modified 56 476 0 Form CMS-10434 (#1)
Form CMS-10434 (#1)
Form CMS-10434 (#1)
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
GenIC #15 (Transition from 0938-1148) - Medicaid State Plan Eligibility New 56 1120 0 Form and Instruction CMS-10434 #15
Form and Instruction CMS-10434 #15
Form and Instruction CMS-10434 #15
Form and Instruction CMS-10434 #15
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
Form and Instruction 1
GenIC #2 - CHIP State Plan Eligibility Unchanged 56 1568 0 Form CMS-10434 (#2)
Form CMS-10434 (#2)
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
GenIC #22 - Health Home State Plan Amendment (SPA) New 30 2400 0 Form CMS-10434 #22
Form CMS-10434 #22
Form CMS-10434 #22
Form CMS-10434 #22
Form CMS-10434 #22
Form CMS-10434 #22
Form CMS-10434 #22
Form CMS-10434 #22
Form CMS-10434 #22
Form CMS-10398 #22
Form CMS-10434 #22
Form CMS-10434 #22
Form CMS-10434 #22
Form CMS-10434 #22
Other-SMDL Letter
Other-CMCS Informational Bulletin
Instruction
GenIC #26 (Transfer from 0938-1148) - Medicaid Adult and Child Core Set Measures New 224 8960 0 Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Form CMS-10434 #26
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
GenIC #47 - Health Home Core Sets New 30 1200 0 Form HHQM1
Form HHQM2
Form HHQM3
Form HHQM4
Form HHQM5
Form HHQM6
Form HHQM7
Form HHQM8
Form HHQM9
Form HHQM10
Form HHQM11
Form HHQM12
Form HHQM13
Form HHQM14
Form HHQM15
Form HHQM16
Form HHQM17
Form HHQM18
Form HHQM19
Form HHQM20
Form HHQM21
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 620 16564 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
To view an IC, click on IC Title