CMS-37-PRA Disclosure

PRA Disclosure Statement

In lieu of the PRA disclosure statement appearing on each form/instructions, the web-based Medicaid and State Children’s Health Insurance Program Budget and Expenditure System (MBES/CBES) includes the PRA disclosure statement as states enter the MBES/CBES. See example below for current approvals.

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 Welcome to MBES/CBES

You have been granted access to the Medicaid And State Children's Health Insurance Program Budget And Expenditure System. You may choose from the options on the left. If at anytime you need to return to this main page, please click on the CMS Logo in the upper left-hand corner of your screen. If you need any assistance during your time here, please feel free to browse through our System Help by clicking the Help button. If you have any further questions that cannot be answered by System Help, please feel free to contact any of the individuals listed below.

Chris Kessler 410-786-7168 CKessler@cms.hhs.gov	Ari Dickstein 410-786-7233 ADickstein@cms.hhs.gov

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To change your email address, click here.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for the collection of the CMS-37 is 0938-0101; the time required to complete the collection is estimated to average 34 hours per response. The expiration for the CMS-37 is September, 30, 2008. The valid OMB control number for the collection of CMS-21 and CMS-21B is 0938-0731; the time to complete this collection is estimated to average 35 hours per response. The valid OMB control number for the collection of CMS-64 information is 0938-0067; the time required to complete this collection is estimated to average 81 hours per response. The expiration date for the CMS-21, CMS-21B and CMS-64 is June 30, 2008. The hour estimates include the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.

If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.