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[Medicaid] GenIC #17 (Revised): CHIP State Plan Eligibility
 
New
 
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 CS22 Yes Yes Fillable Fileable
Form CS23 Yes Yes Fillable Fileable
Form CS24 Yes Yes Fillable Fileable
Form CS27 Yes Yes Fillable Fileable
Form CS28 Yes Yes Fillable Fileable
Form CS29 Yes Yes Fillable Fileable
Form CS31 Yes Yes Fillable Fileable
Instruction Yes Yes Fillable Fileable
Instruction Yes Yes Fillable Fileable
Instruction Yes Yes Fillable Fileable
Instruction Yes Yes Fillable Fileable
Instruction Yes Yes Fillable Fileable
Instruction Yes Yes Fillable Fileable
Instruction Yes Yes Fillable Fileable
Instruction Yes Yes Fillable Fileable
Instruction Yes Yes Fillable Fileable
Instruction Yes Yes Fillable Fileable
Instruction Yes Yes Fillable Fileable
Instruction Yes Yes Fillable Fileable
Instruction Yes Yes Fillable Fileable
Instruction Yes Yes Fillable Fileable
Instruction Yes Yes Fillable Fileable
Instruction Yes Yes Fillable Fileable
Instruction Yes Yes Fillable Fileable
Instruction Yes Yes Fillable Fileable
Instruction Yes Yes Fillable Fileable
Instruction Yes Yes Fillable Fileable
Instruction Yes Yes Fillable Fileable
Instruction 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 97 0 97 0 0 0
Annual IC Time Burden (Hours) 820 0 820 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Public Comment 08/12/2026
Response to Public Comments 08/12/2026
Generic Supporting Statement 08/31/2026
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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