THE HOME AND COMMUNITY-BASED SERVICES WAIVERS MANUAL INSTRUCTIONS

ICR 198904-0938-033

OMB: 0938-0509

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-0509 198904-0938-033
Historical Active 198707-0938-001
HHS/CMS
THE HOME AND COMMUNITY-BASED SERVICES WAIVERS MANUAL INSTRUCTIONS
No material or nonsubstantive change to a currently approved collection   No
Emergency 04/11/1989
Approved with change 04/11/1989
Retrieve Notice of Action (NOA) 04/11/1989
  Inventory as of this Action Requested Previously Approved
09/30/1990 09/30/1990 09/30/1990
50 0 50
10,000 0 10,000
0 0 0

STATE TO OFFER, UNDER A SECRETARIAL WAIVER, A WIDE ARRAY OF HOME AND COMMUNITY-BASED SERVICES TO INDIVIDUA WHO WOULD OTHERWISE BE INSTATUTIONALIZED. STATE REQUESTING A WAIVER MUST DESCRIBE COVERED SERVICES AND PROVIDE ASSURANCES IN WRITING.

None
None


No

1
IC Title Form No. Form Name
THE HOME AND COMMUNITY-BASED SERVICES WAIVERS MANUAL INSTRUCTIONS HCFA-8001

  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 50 50 0 0 0 0
Annual Time Burden (Hours) 10,000 10,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
04/11/1989


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