Medicaid Report on Payables and Receivables (R-199)

OMB 0938-0697

The Chief Financial Officers Act of 1990, as amended by the Government Management and Reform Act of 1994, requires government agencies to produce auditable financial statements. Form CMS-R-199 will collect accounting data from the States on payables and receivables.

The latest form for Medicaid Report on Payables and Receivables (R-199) expires 2023-04-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-R-199 Medicaid Report on Payables and Receivables (R-199) Form
CMS-R-199 Supporting Statement - Part A_ FInal.docx Supporting Statement A
Medicaid Report on Payables and Receivables (R-199) Form

All Historical Document Collections

202002-0938-009 Approved without change	Reinstatement without change of a previously approved collection	2020-02-26
201608-0938-005 Approved without change	Reinstatement without change of a previously approved collection	2016-08-11
201305-0938-003 Approved with change	Reinstatement with change of a previously approved collection	2013-05-03
200910-0938-003 Approved without change	Extension without change of a currently approved collection	2009-10-16
200707-0938-003 Approved without change	No material or nonsubstantive change to a currently approved collection	2007-07-13
200607-0938-012 Approved without change	Extension without change of a currently approved collection	2006-07-13
200312-0938-002 Approved without change	Extension without change of a currently approved collection	2003-12-05
200010-0938-008 Approved without change	Reinstatement with change of a previously approved collection	2000-10-19
199708-0938-003 Approved without change	Reinstatement with change of a previously approved collection	1997-08-11
199611-0938-002 Approved without change	New collection (Request for a new OMB Control Number)	1996-11-12