Information Collection

Annual Report on Home and Community-based Services Waivers

IC 43654 under ICR 201204-0938-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

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	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 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	305	305
Annual IC Time Burden (Hours)	13,115	13,115
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.