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

View Information Collection (IC)

Alternative Benefit Plan (ABP)
 
No New
 
Required to Obtain or Retain Benefits
 
42 CFR 430.12

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10434 Yes Yes Fillable Fileable
Instruction Yes No Printable Only
Instruction Yes No Printable Only
Instruction Yes No Printable Only
Instruction Yes No Printable Only
Instruction Yes No Printable Only
Instruction Yes No Printable Only
Instruction Yes No Printable Only
Instruction Yes No Printable Only
Instruction Yes No Printable Only
Instruction Yes No Printable Only
Instruction Yes No Printable Only
Instruction Yes No Printable Only
Instruction Yes No Printable Only
Instruction Yes No Printable Only
Instruction Yes No Printable Only
Instruction Yes No Printable Only
Instruction Yes No Printable Only
Instruction Yes No Printable Only
Instruction Yes No Printable Only
Instruction Yes No Printable Only

Health Health Care Services

 

56 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 56 0 56 0 0 0
Annual IC Time Burden (Hours) 728 0 728 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
ABP - Webinar Transcript 01/09/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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