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: 0938-1265	ICR Reference No: 201609-0938-003
Status: Historical Active	Previous ICR Reference No: 201605-0938-019
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: 09/18/2016
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/09/2016
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

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.