Information Collection

Annual Report For Home And Community Based Services Waiver (hcfa-371) Annual Expenditure Report For Home And Community Based Services Waiver (hcfa-372)

IC 113315 under ICR 198503-0938-024 · OMB 0938-0272.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0272 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	ANNUAL REPORT FOR HOME AND COMMUNITY BASED SERVICES WAIVER (HCFA-371) ANNUAL EXPENDITURE REPORT FOR HOME AND COMMUNITY BASED SERVICES WAIVER (HCFA-372)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HCFA 371				No	No
Form	HCFA 372				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	12,160	12,160
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.