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[Medicaid] GenIC #59 (Revised): Medicaid Section 1115 Severe Mental Illness (SMI) and Children with Serious Emotional Disturbance (SED) Demonstrations CMCS
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Video: Overview of the Standardized Monitoring Report Process https://cvpcorp-1115pmda.adobeconnect.com/pqopfoy48idv/ No   Printable Only
Other-Video: Populating and Submitting Monitoring Templates https://cvpcorp-1115pmda.adobeconnect.com/pklt7cdlhgjl/ No   Printable Only
Other-Video: Downloading 1115 Monitoring Report Templates https://cvpcorp-1115pmda.adobeconnect.com/p4l83cvhhqda/ No   Printable Only
Form 4 Yes Yes Fillable Fileable
Form 5a Yes Yes Fillable Fileable
Instruction Yes Yes Printable Only
Instruction No   Printable Only
Form 5b Yes Yes Fillable Fileable
Form 7a Yes Yes Fillable Fileable
Form 7b Yes Yes Fillable Fileable
Instruction Yes Yes Printable Only
Form 8b Yes Yes Fillable Fileable
Instruction Yes Yes Fillable Fileable
Other-State Medicaid Directors letter (SMDL) #18-011 No   Printable Only
Form 8a Yes Yes Fillable Fileable
Form 11a Yes Yes Fillable Fileable
Form 11b Yes Yes Fillable Fileable
Form 11c Yes Yes Fillable Fileable
Form 11d Yes Yes Fillable Fileable
Form 11e Yes Yes Fillable Fileable
Form and Instruction 11f Yes Yes Fillable Fileable
Form 11g Yes Yes Fillable Fileable
Form 12a Yes Yes Fillable Fileable
Form 12b Yes Yes Fillable Fileable
Form 12c Yes Yes Fillable Fileable
Form 12d Yes Yes Fillable Fileable
Form 12e Yes Yes Fillable Fileable
Form 12f Yes Yes Fillable Fileable
Form and Instruction 12g Yes Yes Fillable Fileable
Form and Instruction 12h Yes Yes Fillable Fileable
Form 12i Yes Yes Fillable Fileable
Form 13a Yes Yes Fillable Fileable
Form 13b Yes Yes Fillable Fileable
Form 13c Yes Yes Fillable Fileable
Form 13d Yes Yes Fillable Fileable
Form 13e Yes Yes Fillable Fileable
Form and Instruction 13f Yes Yes Fillable Fileable
Form 13g Yes Yes Fillable Fileable

Health Health Care Services

 

151 0
   
State, Local, and Tribal Governments
 
   0 %

  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 329 0 329 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 03/13/2026
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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