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[Medicaid] GenIC #91 (New): State Plan Amendment (SPA) Template for Medicaid Clinic Benefit CMCS
 
New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form Supplement to Attachment 3.1 Yes Yes Fillable Fileable

Health Health Care Services

 

56 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 56 0 56 0 0 0
Annual IC Time Burden (Hours) 1,400 0 1,400 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Generic Supporting Statement 03/04/2025
Public Comment (TTAG) 03/04/2025
Public Comment (ANHB) 03/04/2025
Response to Public Comments 03/04/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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