Annual Report on Home and Community-Based Services Waivers and Supporting Regulations in 42 CFR 440.181 and 441.300-305, Forms HCFA-372 and HCFA-372(S)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type

no available documents/forms check other ICs listed under this ICR

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Annual Report on Home and Community-Based Services Waivers and Supporting Regulations in 42 CFR 440.181 and 441.300-305, Forms HCFA-372 and HCFA-372(S)	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-372(S)				No	No
Form	HCFA-372				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	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	Previously Approved
Annual Number of Responses for this IC	243	20	223
Annual IC Time Burden (Hours)	18,225	1,500	16,725
Annual IC Cost Burden (Dollars)	0	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.