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

Home & Community Based Waiver Requests and Supporting Regulations; 42 CFR 440.180, 441.300-.310 (CMS-8003)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0449 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-8003 Home & Community Based Waiver Requests and Supporting Regulations; 42 CFR 440.180, 441.300-.310 Form
CMS-8003 Section 1915(c) Home and Community Based Services Waiver CMS-8003. 1915c Waiver Application.DOC Form

Information Collection (IC) Details

IC Title:	Home & 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: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 440.180 42 CFR 441.300-310

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-8003	Section 1915(c) Home and Community Based Services Waiver Application	CMS-8003. 1915c Waiver Application.DOC		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

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	136	4	132
Annual IC Time Burden (Hours)	8,010	80	7,930
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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