Information Collection

HIV/AIDS Bureau Core Medical Services Waiver

IC 181012 under ICR 201102-0915-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form Waiver_Definitions HIV/AIDS Bureau Core Medical Services Waiver	Form and Instruction
Waiver_Definitions Waiver_Definitions Waiver_definitions_Updated.doc	Form and Instruction
CMS Waiver Instructions.pdf CMS Waiver Instructions	IC Document
FY2011 Part A Emergency Relief Guidance.doc Guidance Part A	IC Document
CMSwaiver legislation-Parts A-B-C_RW ExtenAct2009.doc Waiver Legislation	IC Document
2011 RW Part B Guidance-CoreMedical Service Waiver.docx Guidance Part B	IC Document
2011 RW PART C Guidance- p.22HRSA-11-091 final.doc Guidance Part C	IC Document

IC Title:

HIV/AIDS Bureau Core Medical Services Waiver

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Waiver_Definitions	Waiver_Definitions	Waiver_definitions_Updated.doc		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	10	-10	20
Annual IC Time Burden (Hours)	65	-65	130
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CMS Waiver Instructions	CMS Waiver Instructions.pdf	12/28/2010
Guidance Part A	FY2011 Part A Emergency Relief Guidance.doc	04/01/2011
Waiver Legislation	CMSwaiver legislation-Parts A-B-C_RW ExtenAct2009.doc	12/28/2010
Guidance Part B	2011 RW Part B Guidance-CoreMedical Service Waiver.docx	12/28/2010
Guidance Part C	2011 RW PART C Guidance- p.22HRSA-11-091 final.doc	12/28/2010

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