Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program (CMS-37)

(CMS-10529) Quarterly Medicaid and CHIP Budget and Expenditure Reporting for the Medical Assistance Program, Administration and CHIP (MBES/CBES Forms CMS-21 and -21B, -37, and -64)

OMB: 0938-1265

IC ID: 213567

Information Collection (IC) Details

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Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program (CMS-37)
 
No Unchanged
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-37 Medicaid Program Budget Report 37 Blank Forms.pdf https://mbescbesval0.medicaid.gov/MBESCBES/Default.aspx Yes Yes Fillable Printable

Health Health Care Services

 

56 0
   
State, Local, and Tribal Governments
 
   100 %

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

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