View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Collection of Dental Benefit Information
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10291 Yes Yes Fillable Printable
Form CMS-10291 Yes Yes Fillable Printable

Health Health Care Services

Medicaid Drug Rebate Program  78 FR 15744

51 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved 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 51 0 0 0 0 51
Annual IC Time Burden (Hours) 1,250 0 -280 0 0 1,530
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crossswalk - Benefits Survey 12/02/2014
Crosswalk - Description of Dental Benefits Provided Under Medicaid and CHIP 12/02/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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