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View Information Collection (IC)
View Information Collection (IC)
IC Title:
[Medicaid] GenIC #56 (Revised): Section 1115 Demonstration: Budget Neutrality Monitoring Workbook
Agency IC Tracking Number:
CMCS
IC Status:
New
Obligation to Respond:
Mandatory
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
GenIC #56
PMDA Budget Neutrality Monitoring Workbook
MASTER BN Workbook Template - v2.14 20250710_CLEAN_508.xlsm
Yes
Yes
Fillable Fileable
Form and Instruction
GenIC #56
State User Budget Neutrality Playbook
#56-Playbook-SU-Budget Neutrality-1115PMDA-20250711.docx
Yes
Yes
Fillable Fileable
Instruction
BN-Monitoring-Workbook-Training-Video-Transcript.docx
Yes
No
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
47
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
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
159
0
159
0
0
0
Annual IC Time Burden (Hours)
1,106
0
1,106
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Generic Supporting Statement
GenIC 56 - Generic Supporting Statement (2025 version 18).docx
09/23/2025
Public Comment (Out of Scope)
Comment - mfb-icog-7fyg.pdf
09/23/2025
Crosswalk :Workbook
BN-Monitoring-Workbook-Crosswalk-of-Changes.xlsx
09/23/2025
Redline: Workbook
MASTER BN Workbook Template - v2.14 20250710_REDLINE.xlsm
09/23/2025
Crosswalk: Playbook
BN Monitoring Playbook Crosswalk of Changes.xlsx
09/23/2025
Redline: Playbook
#56 Playbook-SU-Budget Neutrality-1115PMDA-20250711_REDLINE.docx
09/23/2025
Crosswalk: Video Transcript
BN-Monitoring-Workbook-training-video-transcript-crosswalk-of-changes.xlsx
09/23/2025
Redline: Video Transcript
BN Video Transcript - 20250710_REDLINE.docx
09/23/2025
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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