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

Quarterly Children's Health Insurance Program Statement of Expenditures for Title XXI (CMS-21 and 21B)

OMB: 0938-0731

IC ID: 8399

Information Collection (IC) Details

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Quarterly Children's Health Insurance Program Statement of Expenditures for Title XXI
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-21 Quarterly State Children's Health Insurance Program Statement of Expenditures for Title XXI Summary Sheet CMS-21 forms.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-21B State Children's Health Insurance Program Budget Report for Title XXI Program State Expenditure Plan CMS-21b forms.pdf Yes Yes 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 448 0 0 0 0 448
Annual IC Time Burden (Hours) 7,840 0 0 0 0 7,840
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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