CMS-64 Disclosure Statement

CMS-64 Disclosure Statement.doc

Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program (CMS-64)

CMS-64 Disclosure Statement

OMB: 0938-0067

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PRA Disclosure Statement





According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-0067. The time required to complete this information collection is estimated to average 6 hours per response, including time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

File Typeapplication/msword
File TitlePRA Disclosure Statement
AuthorSharon Jackson
Last Modified ByCMS_DU
File Modified2008-03-27
File Created2008-03-27

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