View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 0938-0933	ICR Reference No: 200411-0938-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: 1932 State Plan Amendment Template, State Plan Requirements, and Supporting Regulations in 42 CFR 438.50
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/25/2005
	Date Received in OIRA: 11/01/2004
Terms of Clearance: Approved. CMS is reminded to classify the obligation to respond accurately. OMB recommends CMS notify States this template is voluntary and may or may not be used at the States' preference.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2008	01/31/2008
Responses	10	0	0
Time Burden (Hours)	100	0	0
Cost Burden (Dollars)	0	0	0

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