Information Collection

SBM Three-year Budget Reports

IC 228022 under ICR 202604-0938-015 · OMB 0938-1119.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10371 SBM Three-Year Budget Template SBM Three-year Budget Reports	Form and Instruction
Form CMS-10371 SBM Three-Year Budget Template SBM Three-year Budget Reports	Form and Instruction
CMS-10371 SBM Three-Year Budget Template SBEBudgetTemplate2026_508Clean.xlsm	Form and Instruction
CMS-10371 SBM Three-Year Budget Template SBEBudgetTemplate2026_508Clean.xlsm	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10371				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 23

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	23	23
Annual IC Time Burden (Hours)	368	368
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

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