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Federal forms, ICRs, and supporting documents

Information Collection

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

IC 213566 under ICR 201410-0938-014 · OMB 0938-1265.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Quarterly Children's Health Insurance Program Statement of Expenditures for Title XXI (CMS-21 and CMS-21B)
 
No New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-21 Quarterly Children’s Health Insurance Program Statement of Expenditures for Title XXI CMS 21 Base.docx Yes Yes Fillable Printable
Form and Instruction CMS-21B Quarterly Children’s Health Insurance Program Statement of Expenditures for Title XXI CMS 21B.docx Yes Yes Fillable Printable

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 0 224 0 0 0
Annual IC Time Burden (Hours) 4,480 0 4,480 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Form Descriptions Form Descriptions.docx 10/22/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.