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State Children's Health Insurance Program and Supporting Regulations in 42 CFR 457.525, 457.740, and 457.1180
[Medicaid] State Children's Health Insurance Program and Supporting Regulations (CMS-R-308)
OMB: 0938-0841
IC ID: 8644
OMB.report
HHS/CMS
OMB 0938-0841
ICR 202411-0938-002
IC 8644
( )
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
Federal Enterprise Architecture Business Reference Module
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
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
16,024,071
0
0
0
0
16,024,071
Annual IC Time Burden (Hours)
803,280
0
0
0
0
803,280
Annual IC Cost Burden (Dollars)
0
0
0
0
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.