Administrative Requirements for Section 6071 of the DRA

[Medicaid] Administrative Requirements for Section 6071 of the Deficit Reduction Act of 2005 (CMS-10249)

OMB: 0938-1053

IC ID: 186838

Documents and Forms

Document Name Document Type
Form CMS-10249 Administrative Requirements for Section 6071 of the DRA Form
MFP-Semi-Annual-Rprt-Help-File.pdf Instruction
MFP-Semi-Annual-Rprt-Help-File.pdf Instruction
MFP-Operational-Protocol.pdf Other-Operational Protocol
MFP-Operational-Protocol.pdf Other-Operational Protocol
MFP-Work-Plan-Help-File.pdf Instruction
MFP-Work-Plan-Help-File.pdf Instruction
Portal Screenshot 1_MFP_SAR_112123_r.pdf Other-Portal Screenshot
State SAR experience.pdf Other-Portal Screenshot
Portal Screenshot 1_MFP_SAR_Admin_Portal_112123_r.pdf Other-Portal Screenshot
Admin SAR experience.pdf Other-Portal Screenshot
Portal Screenshot 1_MFP_WorkPlan_Admin_11212023_r.pdf Other-Portal Screenshot
Admin WP experience.pdf Other-Portal Screenshot
State WP experience.pdf Other-Portal Screenshot
CMS-10249 Semi-Annual Progress Report MFP-Semi-Annual-Report.pdf Form
CMS-10249 Semi-Annual Progress Report MFP-Semi-Annual-Report.pdf Form
CMS-10249 MFP Financial Reporting Forms ABCD MFP_Financial_Reporting_FormsABCD.pdf Form
CMS-10249 MFP Financial Reporting Forms ABCD MFP_Financial_Reporting_FormsABCD.pdf Form
CMS-64.9i, -64.9pi Quarterly Expenditures CMS 64i Expenditure Forms.pdf Form
CMS-64.9i, -64.9pi Quarterly Expenditures CMS 64i Expenditure Forms.pdf Form
CMS-10249 MFP_Budget_Workbook MFP_Budget_Workbook.pdf Form and Instruction
CMS-10249 MFP_Budget_Workbook MFP_Budget_Workbook.pdf Form and Instruction
CMS-10249 Maintenance of Effort (MOE) Form MFP_MOE_Form.pdf Form and Instruction
CMS-10249 Maintenance of Effort (MOE) Form MFP_MOE_Form.pdf Form and Instruction
CMS-10249 Work Plan MFP-Work-Plan.pdf Form
CMS-10249 Work Plan MFP-Work-Plan.pdf Form
MFP-SAR-Crosswalk.pdf Crosswalk: Semi-Annual Report IC Document
MFP-SAR-Crosswalk.pdf Crosswalk: Semi-Annual Report IC Document
MFP-SAR-Help-File-Crosswalk.pdf Crosswalk: Semi Annual Report Help IC Document
MFP-SAR-Help-File-Crosswalk.pdf Crosswalk: Semi Annual Report Help IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Administrative Requirements for Section 6071 of the DRA	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10249	Semi-Annual Progress Report	MFP-Semi-Annual-Report.pdf	Yes	Yes	Fillable Fileable
Form	CMS-10249	MFP Financial Reporting Forms ABCD	MFP_Financial_Reporting_FormsABCD.pdf	Yes	Yes	Fillable Printable
Instruction			MFP-Semi-Annual-Rprt-Help-File.pdf	Yes	Yes	Fillable Printable
Form	CMS-64.9i, -64.9pi, -64.10i, and -64.910pi,	Quarterly Expenditures	CMS 64i Expenditure Forms.pdf	Yes	No	Fillable Printable
Form and Instruction	CMS-10249	MFP_Budget_Workbook	MFP_Budget_Workbook.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10249	Maintenance of Effort (MOE) Form	MFP_MOE_Form.pdf	Yes	Yes	Fillable Fileable
Other-Operational Protocol			MFP-Operational-Protocol.pdf	Yes	Yes	Printable Only
Form	CMS-10249	Work Plan	MFP-Work-Plan.pdf	Yes	Yes	Fillable Fileable
Instruction			MFP-Work-Plan-Help-File.pdf	Yes	No	Printable Only
Other-Portal Screenshot			State SAR experience.pdf	Yes	Yes	Fillable Fileable
Other-Portal Screenshot			Admin SAR experience.pdf	Yes	Yes	Fillable Fileable
Other-Portal Screenshot			Admin WP experience.pdf	Yes	Yes	Fillable Fileable
Other-Portal Screenshot			State WP experience.pdf	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 41	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	410	74	336
Annual IC Time Burden (Hours)	5,003	2,399	2,604
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Crosswalk: Semi-Annual Report	MFP-SAR-Crosswalk.pdf	02/23/2024
Crosswalk: Semi Annual Report Help	MFP-SAR-Help-File-Crosswalk.pdf	02/23/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.