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

View Information Collection (IC)

GenIC #1 - Initial Application
 
Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10434 (#1) Yes Yes Fillable Printable
Form CMS-10434 (#1) Yes Yes Fillable Printable
Form CMS-10434 (#1) Yes Yes Fillable Printable
Instruction No   Printable Only
Instruction No   Printable Only
Instruction No   Printable Only
Instruction No   Printable Only
Instruction No   Printable Only
Instruction No   Printable Only
Instruction No   Printable Only
Instruction No   Printable Only

Health Health Care Services

 

56 0
   
State, Local, and Tribal Governments
 
   100 %

  Requested 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 0 0 0 56
Annual IC Time Burden (Hours) 476 0 0 0 0 476
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
GenIC #1 - Supporting Statement (Initial Application) 03/30/2016
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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