Information Collection

Quarterly Children's Health Insurance Program Statement of Expenditures for Title XXI

IC 8396 under ICR 199806-0938-008 · OMB 0938-0731.

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Documents and forms in this information collection
Document Name	Document Type

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IC Title:

Quarterly Children's Health Insurance Program Statement of Expenditures for Title XXI

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	21P	Yes	Yes
Form	21E	Yes	Yes
Form	HCFA-21	Yes	Yes
Form	21.11A	Yes	Yes
Form	21B	Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 56

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	448	448
Annual IC Time Burden (Hours)	7,840	7,840
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

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