Information Collection

Medicaid Program Budget Report, and Supporting Regs.

IC 7846 under ICR 200807-0938-004 · OMB 0938-0101.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0101 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-37 Medicaid Program Budget Report, and Supporting Regs.	Form and Instruction
CMS-37 State Estimate of Quarterly Grant Awards (In Thousands) CMS37_1.XLS	Form and Instruction
CMS-37.1V Variances in Certification Quarter Estimate From Recent CMS37_1V.xls	Form and Instruction
CMS-37.3 Estimated Medical Assistance by Type of Service CMS37_3.xls	Form and Instruction
CMS-37.3I Estimated Medical Assistance by Type of Service CMS37_3I.xls	Form and Instruction
CMS-37.4 Explanations of Change Between Submissions CMS37_4.xls	Form and Instruction
CMS-37.4M Medicaid SCHIP Expansion Program Benefits CMS37_4M.xls	Form and Instruction
CMS-37.4V Medical Assistance Payments CMS37_4V.xls	Form and Instruction
CMS-37.7 Estimated Average Number of Eligibles During the Year CMS37_7.xls	Form and Instruction
CMS-37.9 State and Local Administration Summary CMS37_9.xls	Form and Instruction
CMS-37.10 State and Local Administration CMS37_10.xls	Form and Instruction
CMS-37.10I Information - State and Local Administration CMS37_10I.xls	Form and Instruction
CMS-37.11 State and Local Administration Payments CMS37_11.xls	Form and Instruction
CMS-37.11V Category Specific Variances in Estimates CMS37_11V.xls	Form and Instruction
CMS-37.12 Other Budget Narratives CMS37_12.xls	Form and Instruction
State Medicare Manual Section 2600WEB-R1.doc State Medicare Manual Section 2600WEB-R1	IC Document
CMS-37-PRA Disclosure.doc CMS-37-PRA Disclosure	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Medicaid Program Budget Report, and Supporting Regs.

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-37	State Estimate of Quarterly Grant Awards (In Thousands) State Estimate of Quarterly Grant Awards	CMS37_1.XLS	No	No	Fillable Fileable
Form and Instruction	CMS-37.1V	Variances in Certification Quarter Estimate From Recent Expenditures	CMS37_1V.xls	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-37.3	Estimated Medical Assistance by Type of Service	CMS37_3.xls	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-37.3I	Estimated Medical Assistance by Type of Service	CMS37_3I.xls	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-37.4	Explanations of Change Between Submissions	CMS37_4.xls	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-37.4M	Medicaid SCHIP Expansion Program Benefits	CMS37_4M.xls	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-37.4V	Medical Assistance Payments	CMS37_4V.xls	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-37.7	Estimated Average Number of Eligibles During the Year	CMS37_7.xls	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-37.9	State and Local Administration Summary	CMS37_9.xls	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-37.10	State and Local Administration	CMS37_10.xls	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-37.10I	Information - State and Local Administration	CMS37_10I.xls	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-37.11	State and Local Administration Payments	CMS37_11.xls	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-37.11V	Category Specific Variances in Estimates	CMS37_11V.xls	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-37.12	Other Budget Narratives	CMS37_12.xls	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 56

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	224	224
Annual IC Time Burden (Hours)	7,616	7,616
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
State Medicare Manual Section 2600WEB-R1	State Medicare Manual Section 2600WEB-R1.doc	07/08/2008
CMS-37-PRA Disclosure	CMS-37-PRA Disclosure.doc	07/08/2008

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.