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

ICR 199812-0938-001

OMB: 0938-0731

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-0731 199812-0938-001
Historical Active 199806-0938-008
HHS/CMS
Quarterly Children's Health Insurance Program Statement of Expenditures for Title XXI
Revision of a currently approved collection   No
Regular
Approved without change 01/28/1999
Retrieve Notice of Action (NOA) 12/01/1998
  Inventory as of this Action Requested Previously Approved
04/30/2002 04/30/2002 06/30/1999
448 0 448
7,840 0 7,840
0 0 0

The form HCFA-21, Quarterly Children's Health Insurance Program Statement of Expenditures for Title XXI, has been used since January 1998 by the respective agencies to report their actual program benefit costs and administrative expenses to the Health Care Financing Administration (HCFA).

None
None


No

1
IC Title Form No. Form Name
Quarterly Children's Health Insurance Program Statement of Expenditures for Title XXI HCFA-21

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 448 448 0 0 0 0
Annual Time Burden (Hours) 7,840 7,840 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

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.
12/01/1998


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