Information Collection

Medicaid Program Budget Report (CMS-37), and Supporting Regs.

IC 7846 under ICR 201404-0938-003 · OMB 0938-0101.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Index.docx	Other-Index of CMS-37 Forms
CMS-37 Medicaid Program Budget Report (Screen Shots) Screenshots of forms.docx	Form
CMS-37 - Crosswalk (rev 4-11-2014 by OSORA PRA).xlsx Crosswalk (CMS-37.10)	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 430.30(a)(1) 42 CFR 430.30(b)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Index of CMS-37 Forms			Index.docx		No		Printable Only
Form	CMS-37	Medicaid Program Budget Report (Screen Shots)	Screenshots of forms.docx		Yes	Yes	Fillable Printable

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
Crosswalk (CMS-37.10)	CMS-37 - Crosswalk (rev 4-11-2014 by OSORA PRA).xlsx	04/15/2014

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