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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.