Experiences with 1115 Medicaid Waivers relative to the Ryan White HIV/AIDS Program and Its Clients and Providers

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 3 RW Part B and ADAP	Form and Instruction	New	Available
Form 4 RW Clinical Providers	Form and Instruction	New	Available
Form 2 RW Part A Administrators and Members of Planning Councils	Form and Instruction	New	Available
Form 1 State medicaid Agency Groups	Form and Instruction	New	Available
Attachment A.pdf	Supplementary Document	Uploaded 2013-06-26	Available
G_IRB Expemption Letter JSI.pdf	Supplementary Document	Uploaded 2013-06-26	Available
Supporting Statement.docx	Supporting Statement A	Uploaded 2013-06-26	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
207739	Discussion Guides	Form and Instruction	New	RW Part B and ADAP
207739	Discussion Guides	Form and Instruction	New	RW Clinical Providers
207739	Discussion Guides	Form and Instruction	New	RW Part A Administrators and Members of Planning Councils
207739	Discussion Guides	Form and Instruction	New	State medicaid Agency Groups

ICR Details

OMB Control No: 0915-0365	ICR Reference No: 201307-0915-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HSA	Agency Tracking No: 19873
Title: Experiences with 1115 Medicaid Waivers relative to the Ryan White HIV/AIDS Program and Its Clients and Providers
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/23/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/11/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2014	36 Months From Approved
Responses	280	0	0
Time Burden (Hours)	560	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Section 1115 of the Social Security Act allows states to develop new approaches to providing Medicaid coverage. This project will examine 1115 waivers that expand Medicaid eligibility to include people living with HIV/AIDS who are not otherwise eligible for services, how Medicaid expansion and 1115 waivers will affect the Ryan White HIV/AIDS Program, and how waivers have prepared states to implement the Affordable Care Act.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: Public Health Service Act
  

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:
	78 FR 23570	04/19/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 41404	07/10/2013
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
Discussion Guides	1, 2, 4, 3	State medicaid Agency Groups ,   RW Part A Administrators and Members of Planning Councils ,   RW Clinical Providers ,   RW Part B and ADAP

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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	280	0	0	280	0	0
Annual Time Burden (Hours)	560	0	0	560	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: This is a new information collection

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Annual Cost to Federal Government: $377,903

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: 07/11/2013

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