View Information Collection Request (ICR) Package

OMB Control No: 0938-1265	ICR Reference No: 201605-0938-019
Status: Historical Active	Previous ICR Reference No: 201410-0938-014
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Quarterly Medicaid and CHIP Budget and Expenditure Reporting for the Medical Assistance Program, Administration and CHIP (CMS-10529)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/31/2016
	Date Received in OIRA: 05/27/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2017	12/31/2017	12/31/2017
Responses	672	0	672
Time Burden (Hours)	17,920	0	17,920
Cost Burden (Dollars)	0	0	0

Abstract: 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.

Authorizing Statute(s): None

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:
	79 FR 46442	08/08/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 62628	10/20/2014
Did the Agency receive public comments on this ICR? Yes

ICR Summary of Burden

	Total Approved	Previously Approved
Annual Number of Responses	672	672
Annual Time Burden (Hours)	17,920	17,920
Annual Cost Burden (Dollars)	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: While this is a new package, it responds to the Terms of Clearance issued on July 2, 2013, under OCN 0938-0067 (CMS-64). The Terms state: "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." In this regard, this package seeks to consolidate CMS-21 and -21B (OMB# 0938-0731), CMS-37 (OMB# 0938-0101), and CMS-64 (OMB# 0938-0067) under a new control number while keeping the individual forms as separate instruments using their original CMS identification numbers. The consolidated package's CMS identification number is CMS-10529. We acknowledge that the control numbers for CMS-21 and -21B (OMB# 0938-0731), CMS-37 (OMB# 0938-0101), and CMS-64 (OMB# 0938-0067) will be formally discontinued upon the approval of CMS-10529.

Annual Cost to Federal Government: $2,373,420

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

View ICR - OIRA Conclusion