Annual Report on Home and Community-based Services Waivers

ICR 200607-0938-007

OMB: 0938-0272

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
0938-0272 200607-0938-007
Historical Active 200311-0938-002
HHS/CMS
Annual Report on Home and Community-based Services Waivers
Extension without change of a currently approved collection   No
Regular
Approved without change 10/11/2006
Retrieve Notice of Action (NOA) 07/12/2006
  Inventory as of this Action Requested Previously Approved
10/31/2009 36 Months From Approved 12/31/2006
287 0 277
20,775 0 20,775
0 0 0

States with an approved waiver under Section 1915(c) of the Act are required to submit the HCFA-372 or HCFA-372(s) annually in order for HCFA to: (1) verify that state assurances regarding waiver cost-neutrality are met, and (2) determine the waiver's impact on the type, amount and cost of services provided under the state plan and health and welfare of recipients.

None
None


No

1
IC Title Form No. Form Name
Annual Report on Home and Community-based Services Waivers 372(S)

  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 287 277 0 10 0 0
Annual Time Burden (Hours) 20,775 20,775 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.
07/12/2006


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