Information Collection Request
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) -- (CMS-10529)
ICR 202404-0938-020 · OMB 0938-1265 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-64 Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program (CMS-64) |
Form | Modified | Repair queued |
| Form CMS-37 Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program (CMS-37) |
Form | Modified | Repair queued |
| Form CMS-21 Quarterly Children's Health Insurance Program Statement of Expenditures for Title XXI (CMS-21 and CMS-21B) |
Form and Instruction | Modified | Available |
 CMS-10529 - Supporting Statement A (2024 version 5).docx |
Supporting Statement A | Uploaded 2024-04-25 | Available |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 213568 |  Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program (CMS-64) |
Form | Modified | |
| 213567 | Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program (CMS-37) |
Form | Modified | |
| 213566 | Quarterly Children's Health Insurance Program Statement of Expenditures for Title XXI (CMS-21 and CMS-21B) |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1265 |
| Type of Information Collection | Extension without change of a currently approved collection |
| Previous ICR Reference No | 202311-0938-003 |
| Agency Tracking No | CMCS |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |