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

View Information Collection (IC)

Bundle 3 GenICs - Health Home SPA (#22), Primary Care Payment Increase (#23), and Medicaid Accountability (#24)
 
New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10398 (#22) Yes Yes Fillable Printable
Form CMS-10398 (#22) Yes Yes Fillable Printable
Instruction Yes Yes Fillable Printable
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
Form CMS-10398 (#23) Yes Yes Fillable Printable
Instruction Yes No Printable Only
Instruction Yes No Printable Only
Form CMS-10398 (#23) Yes Yes Fillable Printable

Health Health Care Services

 

52 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 160 0 0 0 0 0
Annual IC Time Burden (Hours) 6,720 0 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Supporting Statement - Health Home (#22) 09/30/2013
Supporting Statement - Primary Care Payment Increase (#23) 09/30/2013
Supporting Statement - Medicaid Accountability (#24) 09/30/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.