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

View Information Collection (IC)

GenIC #22 (Revision): Health Home State Plan Amendment (SPA) CMCS
 
New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10434 #22 Yes Yes Fillable Fileable
Form CMS-10434 #22 Yes Yes Fillable Fileable
Form CMS-10434 #22 Yes Yes Fillable Fileable
Form CMS-10434 #22 Yes Yes Fillable Fileable
Form CMS-10434 #22 Yes Yes Fillable Fileable
Form CMS-10434 #22 Yes Yes Fillable Fileable
Form CMS-10434 #22 Yes Yes Fillable Fileable
Form CMS-10434 #22 Yes Yes Fillable Fileable
Form CMS-10434 #22 Yes Yes Fillable Fileable
Form CMS-10434 #22 Yes Yes Fillable Fileable
Form CMS-10434 #22 Yes Yes Fillable Fileable
Form CMS-10434 #22 Yes Yes Fillable Fileable
Form CMS-10434 #22 Yes Yes Fillable Fileable
Form CMS-10434 #22 Yes Yes Fillable Fileable
Form CMS-10434 #22 Yes Yes Fillable Fileable
Form CMS-10434 #22 Yes Yes Fillable Fileable
Other-1945 Implementation Guide No   Printable Only
Other-1945A Implementation Guide Yes No Printable Only

Health Health Care Services

 

54 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 18 0 18 0 0 0
Annual IC Time Burden (Hours) 54 0 54 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
State Medicaid Director Letter (SMDL) #10-024 09/30/2023
State Medicaid Director Letter (SMDL) #22-004 09/30/2023
CMCS Informational Bulletin (CIB) 12-22-2010 09/30/2023
CMCS Informational Bulletin (CIB) 10-20-2021 09/30/2023
Track Change: 1945 Implementation Guide 09/30/2023
Track Change: 1945A Implementation Guide 09/30/2023
Track Change: HH8 – Health Homes Monitoring, Quality Measurement, and Evaluation 09/30/2023
Track Change: HH8A – 1945A Health Homes Monitoring, Quality Measurement, and Evaluation 09/30/2023
Generic Supporting Statement 09/30/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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