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GenIC #57 (Revision): Medicaid Section 1115 Substance Use Disorder (SUD) Demonstration: Monitoring Reports Documents and Templates CMCS
 
New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Yes Yes Printable Only
Form CMS-10398 #57 Yes Yes Fillable Fileable
Form and Instruction CMS-10398 #57 Yes Yes Fillable Fileable
Instruction Yes Yes Printable Only
Form CMS-10398 #57 Yes Yes Fillable Fileable
Form and Instruction CMS-10398 #57 Yes Yes Fillable Fileable
Instruction https://cvpcorp-1115pmda.adobeconnect.com/p4l83cvhhqda/ Yes No Printable Only

Health Health Care Services

 

35 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 596 0 596 0 0 0
Annual IC Time Burden (Hours) 5 0 5 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Generic Supporting Statement 03/15/2022
Crosswalk: Monitoring Protocol Instructions 03/15/2022
Crosswalk: Monitoring Protocol Template 03/15/2022
Crosswalk: Monitoring Protocol Workbook 03/15/2022
Crosswalk: Monitoring Report Instructions 03/15/2022
Crosswalk: Monitoring Report Template 03/15/2022
Crosswalk: Monitoring Report Workbook 03/15/2022
SMDL #17-003 03/15/2022
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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