OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

[Medicaid] Income and Eligibility Verification System Reporting and Supporting Regs. (CMS-R-74)

OMB 0938-0467 · HHS/CMS.

OMB 0938-0467

This collection is necessary to verify income and eligibility requirements for Medicaid recipients, as required by Section 1137 of the Social Security Act.

The latest form for [Medicaid] Income and Eligibility Verification System Reporting and Supporting Regs. (CMS-R-74) expires 2029-04-30 and can be found here.

Latest Forms, Documents, and Supporting Material
Document
Name
Form
Supporting Statement A
Supplementary Document
All Historical Document Collections
 Extension without change of a currently approved collection 2025-11-26
Approved without change
 Extension without change of a currently approved collection 2022-04-29
Approved without change
 Extension without change of a currently approved collection 2019-01-29
Approved with change
 Extension without change of a currently approved collection 2015-06-29
Approved without change
 Revision of a currently approved collection 2012-03-28
Approved without change
 Extension without change of a currently approved collection 2009-03-10
Approved without change
 Extension without change of a currently approved collection 2006-01-17
Approved without change
 Extension without change of a currently approved collection 2002-07-30
Approved without change
 No material or nonsubstantive change to a currently approved collection 1999-09-30
Approved without change
 Extension without change of a currently approved collection 1999-03-16
Approved without change
 Reinstatement without change of a previously approved collection 1996-02-16
Approved without change
 Reinstatement with change of a previously approved collection 1992-07-31
Approved without change
 Revision of a currently approved collection 1989-04-06
Approved without change
 New collection (Request for a new OMB Control Number) 1986-02-28