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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0938-0067
ICR Reference No:
201305-0938-020
Status:
Historical Active
Previous ICR Reference No:
201103-0938-010
Agency/Subagency:
HHS/CMS
Agency Tracking No:
19682
Title:
Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program (CMS-64)
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
07/02/2013
Retrieve Notice of Action (NOA)
Date Received in OIRA:
05/28/2013
Terms of Clearance:
Approved consistent with the understanding that, within 18 months, CMS plans to obtain approval for the electronic MBES system. Once the MBES is approved, CMS will discontinue the following OMB control numbers and incorporate the data collection instruments into MBES: 0938-0101, 0938-0067, and 0938-0731.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
01/31/2015
36 Months From Approved
04/30/2014
Responses
224
0
224
Time Burden (Hours)
18,144
0
18,144
Cost Burden (Dollars)
0
0
0
Abstract:
The State Medicaid agencies use the Form CMS-64, Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program to report their actual program benefit costs and administrative expenses to the Centers for Medicare and Medicaid Services (CMS). CMS uses this information to compute the Federal financial participation for the State's Medicaid Program costs.
Authorizing Statute(s):
Statute at Large:
19 Stat. 1903
PL:
Pub.L. 105 - 33 1900
Name of Law: State Children's Health Insurance Program
PL:
Pub.L. 105 - 100 1903
Name of Law: Payments to States
PL:
Pub.L. 111 - 152 4107 and 5001
Name of Law: Affordable care Act of 2009
PL:
Pub.L. 111 - 148 2301, 2501, and 2703
Name of Law: Affordable Care Act of 2009
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
78 FR 16507
03/15/2013
30-day Notice:
Federal Register Citation:
Citation Date:
78 FR 31555
05/24/2013
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program
CMS-64
Quarterly Medicaid Assistance Expenditures For the Medical Assistance Program
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
224
224
0
0
0
0
Annual Time Burden (Hours)
18,144
18,144
0
0
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Annual Cost to Federal Government:
$2,061,212
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
Yes
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Mitch Bryman 410 786-5258 Mitch.Bryman@cms.hhs.gov
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
05/28/2013
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