OMB control number
Quarterly Medicaid and CHIP Budget and Expenditure Reporting for the Medical Assistance Program, Administration and CHIP (MBES/CBES Forms CMS-21 and -21B, -37, and -64) -- (CMS-10529)
OMB 0938-1265 · HHS/CMS.
OMB 0938-1265
MBES/CBES is a financial reporting system that produces Budget and expenditures for Medical Assistance and Children's Health Insurance Program. All forms (CMS-21, -21B, -37, and -64) are to be filed on a quarterly basis and need to be certified by the States to the CMS.
The latest form for Quarterly Medicaid and CHIP Budget and Expenditure Reporting for the Medical Assistance Program, Administration and CHIP (MBES/CBES Forms CMS-21 and -21B, -37, and -64) -- (CMS-10529) expires 2027-07-31 and is listed under ICR 202404-0938-020.
Latest Forms, Documents, and Supporting Material
Form CMS-64 (Series) Medical Assistance Expenditures by Type of Service For the Medical Assistance Program
Form CMS-21 (Series) Quarterly Children’s Health Insurance Program Statement of Expenditures for Title XXI
CMS-10529_JustificationNonsubstantiveChange (2026 version 2).docx
Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program (CMS-64)All Historical Document Collections
OMB Details
Quarterly Children's Health Insurance Program Statement of Expenditures for Title XXI (CMS-21 and CMS-21B)
Federal Enterprise Architecture: Health - Health Care Services
| Form | Name | Electronic access | Type |
|---|---|---|---|
| Form CMS-21 | Quarterly Children’s Health Insurance Program Statement of Expenditures for Title XXI | Fillable Printable | Form and instruction |
| Form CMS-21B | Children's Health Insurance Program Budget Report for the Title XXI Program State Expenditure Plan | Fillable Fileable | Form and instruction |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.