Information Collection

Annual Report on Home and Community-based Services Waivers

IC 43654 under ICR 200901-0938-011 · OMB 0938-0272.

⚠️ Notice: This information collection may be referencing outdated material.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
Form CMS-372 Annual Report on Home and Community-based Services Waivers Form and Instruction
CMS-372 Annual Report on Home and Community Based Waivers Blank 372 Screenshots.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Annual Report on Home and Community-based Services Waivers	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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 and Instruction	CMS-372	Annual Report on Home and Community Based Waivers	Blank 372 Screenshots.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 49	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	305	18	287
Annual IC Time Burden (Hours)	13,115	-7,660	20,775
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.