PRA IC List
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Agenda
Reg Review
ICR
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
893
17403
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 - HIDE, FIDE, and AIP Contract Requirements Matrix
Total burden requested under this ICR:
893
17403
0
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