Collection of Dental Benefit Information

[Medicaid] State Collection and Reporting of Dental Provider and Benefit Package Information on the Insure Kids Now! Website and Hotline (CMS-10291)

OMB: 0938-1065

IC ID: 189779

Documents and Forms

Document Name Document Type
Form CMS-10291 Collection of Dental Benefit Information Form
CMS-10291 Insure Kids Now Children’s Dental Benefits Survey SummaryofBenefitsFormPlain.pdf Form
Summary of Benefits Page - PRA Text.png Other-Screenshot: Summary of Benefits Form