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

Federal Form Document

Forms and Documents

Document Name	Status
Form CMS-64 Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program (CMS-64) Form	Modified
Form CMS-37 Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program (CMS-37) Form	Modified
Form CMS-21 Quarterly Children's Health Insurance Program Statement of Expenditures for Title XXI (CMS-21 and CMS-21B) Form and Instruction	Modified
CMS-10529 - Supporting Statement A (2024 version 5).docx Supporting Statement A	2024-04-25

IC Document Collections

IC ID	Document Title	Status
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