Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Active GenICs (NOA issued 07-29-2026) New 14559 231896 0 Form and Instruction See NOA
GenIC #100 New (Medicaid Community Engagement: Good Faith Effort Exemptions and Quarterly Reporting) New 18 380 0
GenIC #101 New (Medicaid Community Engagement: Short-term Hardship Exception Requests) New 105300192 1208364 0
GenIC #11 Revised (MAGI-Based Eligibility Verification Plan) New 156 5520 0 Form and Instruction GenIC #11
Form and Instruction GenIC #11
Form and Instruction GenIC #11
GenIC #35 Revised (Eligibility and Enrollment Performance Indicators) New 2324 11352 0 Other-Performance Indicators Data Dictionary
Form and Instruction GenIC #35
GenIC #66 Revised (Eligibility Processing Data Report) New 2388 8872 0 Form and Instruction GenIC #66
Other-Eligibility Processing Data Report Specifications
Other-Data Report Instrument Metrics
Other-SHO# 24-002
Form and Instruction GenIC #66
Form and Instruction GenIC #66
[Medicaid] GenIC #17 (Revised): CHIP State Plan Eligibility New 97 820 0 Form CS3
Form CS7
Form CS8
Form CS9
Form CS10
Form CS11
Form CS12
Form CS13
Form CS14
Form CS15
Form CS16
Form CS17
Form CS18
Form CS19
Form CS20
Form CS21
Form CS22
Form CS23
Form CS24
Form CS27
Form CS28
Form CS29
Form CS31
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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 New 30 5 0 Form and Instruction CMS-10398 #34
[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 New 82 168 0 Form and Instruction GenIC #34
[Medicaid] GenIC #99 (New): Medicaid Certified Community Behavioral Health Clinic (CCBHC) Services State Plan Amendment Coverage Template New 56 280 0 Form and Instruction GenIC #99
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 105319902 1467657 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
To view an IC, click on IC Title