Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Dual Eligible Special Needs Plan Contract with the State Medicaid Agency Modified 525 22432 0 Form and Instruction CMS-10796 D-SNP State Medicaid Agency(ies) Contract(s): Attestations
Form and Instruction CMS-10796 Appendix B - D-SNP State Medicaid Agency Contract Matrix.docx
Form and Instruction CMS-10796 Appendix C - Special Needs Plan (SNP) Contract Status Review Matrix
Total burden requested under this ICR: 525 22432 0  
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