Information Collection

State Children's Health Insurance Program and Supporting Regulations in 42 CFR 457.525, 457.740, and 457.1180

IC 8644 under ICR 202411-0938-002 · OMB 0938-0841.

Documents and Forms

Document Name Document Type
SEDSInstructions.pdf Instruction
CMS-R-308 Statistical Enrollment Reports Screenshots (Forms: CMS-2 Complete SEDS Report_Example.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State Children's Health Insurance Program and Supporting Regulations in 42 CFR 457.525, 457.740, and 457.1180	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 457.525 42 CFR 457.350 42 CFR 457.740 42 CFR 457.1180

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			SEDSInstructions.pdf		Yes	No	Printable Only
Form	CMS-R-308	Statistical Enrollment Reports Screenshots (Forms: CMS-21E; CMS-64.21E; CMS-64.EC; CMS-21PW; and Form Gender, Race, Ethnicity)	Complete SEDS Report_Example.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 51	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	16,024,071	16,024,071
Annual IC Time Burden (Hours)	803,280	803,280
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.