Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program

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

OMB: 0938-0067

IC ID: 7827

Information Collection (IC) Details

View Information Collection (IC)

Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program
 
No Modified
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-64 Quarterly Medicaid Statement of Expenditures for the Medical Assitance Program CMS-64 Forms.pdf No No Fillable Fileable

Health Health Care Services

 

56 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 224 0 0 0 0 224
Annual IC Time Burden (Hours) 18,144 0 0 0 0 18,144
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS-64 Disclosure Statement CMS-64 Disclosure Statement.doc 06/06/2008
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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