HIV/AIDS Bureau Core Medical Services Waiver

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Waiver_Definitions HIV/AIDS Bureau Core Medical Services Waiver	Form and Instruction	Modified	Available
2011 RW PART C Guidance- p.22HRSA-11-091 final.doc	Supplementary Document	Uploaded 2010-12-28	Available
2011 RW Part B Guidance-CoreMedical Service Waiver.docx	Supplementary Document	Uploaded 2010-12-28	Available
CMSwaiver legislation-Parts A-B-C_RW ExtenAct2009.doc	Supplementary Document	Uploaded 2010-12-28	Available
2011RW Part A Guidance-CoreMedical ServiceWaiver.pdf	Supplementary Document	Uploaded 2010-12-28	Available
CMS Waiver Instructions.pdf	Supplementary Document	Uploaded 2010-12-28	Available
Core Medical Services WaiverSupportingStatmt-Final12 27 10.doc	Supporting Statement A	Uploaded 2010-12-28	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
181012	HIV/AIDS Bureau Core Medical Services Waiver	Form and Instruction	Modified

ICR Details

OMB Control No: 0915-0307	ICR Reference No: 201102-0915-004
Status: Historical Active	Previous ICR Reference No: 200801-0915-004
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: HIV/AIDS Bureau Core Medical Services Waiver
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/18/2011
	Date Received in OIRA: 02/23/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2014	36 Months From Approved	04/30/2011
Responses	10	0	20
Time Burden (Hours)	65	0	130
Cost Burden (Dollars)	0	0	0

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Abstract: The Ryan White HIV/AIDS Treatment Extension Act of 2009 requires that grantees receiving funds under Parts A, B, and C expend 75% of funding on core medical services, including anitretroviral drugs, for individuals with HIV/AIDS identified and eligible under the legislation. Sections of the Act permit a waiver with respect to the required portion of funding for core medical services. In order to request a waiver, grantees must submit a request and provide supporting information and documentation along with the grant application to ensure compliance with the Act.

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Authorizing Statute(s): PL: Pub.L. 109 - 415 2612(b) Name of Law: Ryan White HIV/AIDS Treatment Modernization Act of 2006
   PL: Pub.L. 109 - 415 2651(c) Name of Law: Ryan White HIV/AIDS Treatment Modernization Act of 2006
   PL: Pub.L. 111 - 87 2671 Name of Law: Ryan White HIV/AIDS Treatment Extension Act of 2009
   PL: Pub.L. 109 - 415 2604(c) Name of Law: Ryan White HIV/AIDS Treatment Modernization Act of 2006
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 55583	09/13/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 9030	02/16/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
HIV/AIDS Bureau Core Medical Services Waiver	Waiver_Definitions	Waiver_Definitions

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ICR Summary of Burden

table that charts list of burden

	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	10	20	0	0	-10	0
Annual Time Burden (Hours)	65	130	0	0	-65	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $731

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 02/23/2011

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