Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program (CMS-64)

Quarterly Medicaid and CHIP Budget and Expenditure Reporting for the Medical Assistance Program, Administration and CHIP (CMS-10529)

OMB: 0938-1265

IC ID: 213568

Information Collection (IC) Details

View Information Collection (IC)

Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program (CMS-64)
 
No New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-64 (Summary) Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program CMS 64 Summary.docx Yes Yes Fillable Printable
Form and Instruction CMS-64.9 (base) Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program CMS 64.9 base.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) 8,960 0 8,960 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk Crosswalk - CMS-64.pdf 10/22/2014
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.

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