Information Collection

Home and Community-Based Waiver Requests and Supporting Regulations; 42 CFR 440.180, 441.300-.310

IC 8071 under ICR 200205-0938-013 · OMB 0938-0449.

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Information Collection (IC) Details

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IC Title:	Home and Community-Based Waiver Requests and Supporting Regulations; 42 CFR 440.180, 441.300-.310	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	CMS-8003				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	132	4	128
Annual IC Time Burden (Hours)	7,930	70	7,860
Annual IC Cost Burden (Dollars)	0	0	0

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Title	Document	Date Uploaded

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