Dual Eligible Special Needs Plan Contract with the State Medicaid Agency (CMS-10796)

ICR 202503-0938-002

OMB: 0938-1410

Federal Form Document

Forms and Documents

Document Name	Status
Form CMS-10796 Dual Eligible Special Needs Plan Contract with the State Medicaid Agency Form and Instruction	Modified
CMS-10796 - Supporting Statement A.docx Supporting Statement A	2025-03-21
SMAC PRA instrument Crosswalk - 30-Day Notice .docx Supplementary Document	2025-03-18
CMS-10796 60-Day Comment Responses.docx Supplementary Document	2025-03-18
SMAC PRA instrument crosswalk.pdf Supplementary Document	2025-03-18

IC Document Collections

IC ID	Document Title	Status
251117	Dual Eligible Special Needs Plan Contract with the State Medicaid Agency Form and Instruction	Modified