OMB.report

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 202404-0938-020 · OMB 0938-1265.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
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 Modified
 
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 Forms 508 Compliant.pdf Yes Yes Fillable Printable
Form and Instruction CMS-21B Children's Health Insurance Program Budget Report for the Title XXI Program State Expenditure Plan 21B FORMS MACFIN 23Jun2023.pdf Yes Yes Fillable Fileable

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 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

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.