Information Collection

HIV/AIDS Bureau Core Medical Services Waiver

IC 181012 under ICR 200707-0915-001 · OMB 0915-0307.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0307 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Waiver definitions.doc	Instruction
hiv waiver law.doc waiver legislation	IC Document
waiver letters 2007.pdf waiver letters	IC Document
waiver memo 2007.pdf waiver memo 2007	IC Document

IC Title:

HIV/AIDS Bureau Core Medical Services Waiver

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Waiver definitions.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	130	130
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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