Medicaid Use Report

ICR 202312-0960-003

OMB: 0960-0267

Federal Form Document

Forms and Documents

Document Name	Status
Addendum - 0267 (Final).docx Supplementary Document	2023-12-29
Supporting Statement - 0267 (Final).docx Supporting Statement A	2023-12-29

IC Document Collections

IC ID	Document Title	Status
9170	Medicaid Use Report Other-Internal Screens	Modified