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GenIC #17 (Revision): CHIP State Plan Eligibility CMCS
 
Unchanged
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CS3 Yes Yes Fillable Fileable
Form CS7 Yes Yes Fillable Fileable
Form CS8 Yes Yes Fillable Fileable
Form CS9 Yes Yes Fillable Fileable
Form CS10 Yes Yes Fillable Fileable
Form CS11 Yes Yes Fillable Fileable
Form CS12 Yes Yes Fillable Fileable
Form CS13 Yes Yes Fillable Fileable
Form CS14 Yes Yes Fillable Fileable
Form CS15 Yes Yes Fillable Fileable
Form CS16 Yes Yes Fillable Fileable
Form CS17 Yes Yes Fillable Fileable
Form CS18 Yes Yes Fillable Fileable
Form CS19 Yes Yes Fillable Fileable
Form CS20 Yes Yes Fillable Fileable
Form CS21 Yes Yes Fillable Fileable
Form CS23 Yes Yes Fillable Fileable
Form CS24 Yes Yes Fillable Fileable
Form CS27 (Revised) Yes Yes Fillable Fileable
Form CS28 Yes Yes Fillable Fileable
Form CS29 Yes Yes Fillable Fileable
Other-IG_CS3 Yes No Printable Only
Other-IG_CS7 Yes No Printable Only
Other-IG_CS8 Yes No Printable Only
Other-IG_CS9 Yes No Printable Only
Other-IG_CS10 Yes No Printable Only
Other-IG_CS11 Yes No Printable Only
Other-IG_CS12 Yes No Printable Only
Other-IG_CS13 Yes No Printable Only
Other-IG_CS14 Yes No Printable Only
Other-IG_CS15 Yes No Printable Only
Other-IG_CS16 Yes No Printable Only
Other-IG_CS17 Yes No Printable Only
Other-IG_CS18 Yes No Printable Only
Other-IG_CS19 Yes No Printable Only
Other-IG_CS20 Yes No Printable Only
Other-IG_CS21 Yes No Printable Only
Other-IG_CS23 Yes No Fillable Fileable
Other-IG_CS24 Yes No Fillable Fileable
Other-IG_CS27 (Revised) Yes No Printable Only
Other-IG_CS28 Yes No Printable Only
Other-IG_CS29 Yes No Fillable Fileable

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) 5 0 0 0 0 5
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Generic Supporting Statement 11/14/2023
Track Change: CS27 SPA Template 11/14/2023
Track Change: IG_CS27 11/14/2023
Crosswalk: CS27 SPA Template 11/14/2023
Crosswalk: IG_CS27 11/14/2023
(SHO #23-004) Continuous Eligibility for Children 11/14/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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