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

View Information Collection (IC)

[Medicaid] GenIC #15 (Revision): Medicaid State Plan Eligibility CMCS
 
New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction RU A1 Yes Yes Fillable Fileable
Form and Instruction RU A2 Yes Yes Fillable Fileable
Form and Instruction RU A3 Yes Yes Fillable Fileable
Form and Instruction RU A4 Yes Yes Fillable Fileable
Form and Instruction RU A5 Yes Yes Fillable Fileable
Form and Instruction RU I1 Yes Yes Fillable Fileable
Form and Instruction RU I2 Yes Yes Fillable Fileable
Form and Instruction RU I3 Yes Yes Fillable Fileable
Form and Instruction RU I4 Yes Yes Fillable Fileable
Form and Instruction RU I5 Yes Yes Fillable Fileable
Form and Instruction RU S2 Yes Yes Fillable Fileable
Form and Instruction RU S2t Yes Yes Fillable Fileable
Form and Instruction RU S3 Yes Yes Fillable Fileable
Form and Instruction RU S3a Yes Yes Fillable Fileable
Form and Instruction RU S4 Yes Yes Fillable Fileable
Form and Instruction RU S10 Yes Yes Fillable Fileable
Form and Instruction RU S10t Yes Yes Fillable Fileable
Form and Instruction RU S11 Yes Yes Fillable Fileable
Form and Instruction RU S11a Yes Yes Fillable Fileable
Form and Instruction RU S13a Yes Yes Fillable Fileable
Form and Instruction RU S14 Yes Yes Fillable Fileable
Form and Instruction RU S14a Yes Yes Fillable Fileable
Form and Instruction RU S14t Yes Yes Fillable Fileable
Form and Instruction RU S16 Yes Yes Fillable Fileable
Form and Instruction RU S17 Yes Yes Fillable Fileable
Form and Instruction RU S21 Yes Yes Fillable Fileable
Form and Instruction RU S25 Yes Yes Fillable Fileable
Form and Instruction RU S25a Yes Yes Fillable Fileable
Form and Instruction RU S28 Yes Yes Fillable Fileable
Form and Instruction RU S28a Yes Yes Fillable Fileable
Form and Instruction RU S28t Yes Yes Fillable Fileable
Form and Instruction RU S30 Yes Yes Fillable Fileable
Form and Instruction RU S30t Yes Yes Fillable Fileable
Form and Instruction RU S32 Yes Yes Fillable Fileable
Form and Instruction RU S32a Yes Yes Fillable Fileable
Form and Instruction RU S32t Yes Yes Fillable Fileable
Form and Instruction RU S33 Yes Yes Fillable Fileable
Form and Instruction RU S33a Yes Yes Fillable Fileable
Form and Instruction RU S50 Yes Yes Fillable Fileable
Form and Instruction RU S50a Yes Yes Fillable Fileable
Form and Instruction RU S51 Yes Yes Fillable Fileable
Form and Instruction RU S52 Yes Yes Fillable Fileable
Form and Instruction RU S53 Yes Yes Fillable Fileable
Form and Instruction RU S54 Yes Yes Fillable Fileable
Form and Instruction RU S55 Yes Yes Fillable Fileable
Form and Instruction RU S57 Yes Yes Fillable Fileable
Form and Instruction RU S59 Yes Yes Fillable Fileable
Form and Instruction RU S59a Yes Yes Fillable Fileable
Form and Instruction RU S88 Yes Yes Fillable Fileable
Form and Instruction RU S89 Yes Yes Fillable Fileable
Form and Instruction RU S94 Yes Yes Fillable Fileable
Form and Instruction RU S94a Yes Yes Fillable Fileable
Form and Instruction RU S97 Yes Yes Fillable Fileable
Instruction 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 100 0 100 0 0 0
Annual IC Time Burden (Hours) 1,936 0 1,936 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Generic Supporting Statement 07/20/2026
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.