This information
collection is approved on an emergency basis under the following
condition: Upon the next submission, HCFA shall develop an
appropriate format for States to report numbers of children, by
service delivery system, that are served in the CHIP based on
Federal poverty income level categories and under the age
categories.
Inventory as of this Action
Requested
Previously Approved
12/31/1998
12/31/1998
05/31/2001
224
0
224
16,464
0
11,984
0
0
0
The form HCFA-64, Quarterly Medicaid
Statement of Expenditures for the Medical Assistance Program, has
been used since January 1980 by the Medicaid State agencies to
report their actual program benefit costs and administrative
expenses to the Health Care Financing Administration (HCFA). HCFA
uses this information to compute the Federal financial
participation (FFP) for the State's Medicaid Program costs. The
form HCFA-64 has been modified over the years to incorporate
legislative, regulatory, and operational changes. At this time, we
are not requesting any revisions to the existing Office of
Management....
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.
Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program