Medicaid Program Budget Report, and Supporting Regs.

Forms and Documents

Document Name	Status
Form CMS-37 Medicaid Program Budget Report, and Supporting Regs. Form and Instruction	Modified
CMS-37-PRA Disclosure.doc Supplementary Document	2008-07-08
State Medicare Manual Section 2600WEB-R1.doc Supplementary Document	2008-07-08
CMS-37 Supporting Statement.doc Supporting Statement A	2008-07-08

IC Document Collections

IC ID	Document Title	Status
7846	Medicaid Program Budget Report, and Supporting Regs. Form and Instruction	Modified

ICR Details

OMB Control No: 0938-0101	ICR Reference No: 200807-0938-004
Status: Historical Active	Previous ICR Reference No: 200507-0938-006
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicaid Program Budget Report, and Supporting Regs.
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/08/2008
	Date Received in OIRA: 07/29/2008
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2011	36 Months From Approved	12/31/2008
Responses	224	0	224
Time Burden (Hours)	7,616	0	7,616
Cost Burden (Dollars)	0	0	0

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Abstract: The Medicaid Program Budget Report is prepared by the State Medicaid Agencies and is used by CMS for 1) developing National Medicaid Budget estimates, 2) qualification of Budget Assumptions, 3) the issuance of quarterly Medicaid Grant Awards, and 4) collection of projected State receipts of donations and taxes.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 24293	05/02/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 38226	07/03/2008
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Medicaid Program Budget Report, and Supporting Regs.	CMS-37, CMS-37.1V, CMS-37.3, CMS-37.3I, CMS-37.4, CMS-37.4M, CMS-37.4V, CMS-37.7, CMS-37.9, CMS-37.10, CMS-37.10I, CMS-37.11, CMS-37.11V, CMS-37.12	State Estimate of Quarterly Grant Awards (In Thousands) State Estimate of Quarterly Grant Awards ,   Variances in Certification Quarter Estimate From Recent Expenditures ,   Estimated Medical Assistance by Type of Service ,   Estimated Medical Assistance by Type of Service ,   Explanations of Change Between Submissions ,   Medicaid SCHIP Expansion Program Benefits ,   Medical Assistance Payments ,   Estimated Average Number of Eligibles During the Year ,   State and Local Administration Summary ,   State and Local Administration ,   Information - State and Local Administration ,   State and Local Administration Payments ,   Category Specific Variances in Estimates ,   Other Budget Narratives

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ICR Summary of Burden

	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	224	224	0	0	0	0
Annual Time Burden (Hours)	7,616	7,616	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $1,006,256

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 07/29/2008

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