Information Collection

Home & Community Based Waiver Requests and Supporting Regulations; 42 CFR 440.180, 441.300-.310

IC 8072 under ICR 201309-0938-006 · OMB 0938-0449.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0449 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-8003 Home & Community Based Waiver Requests and Supporting Regulations; 42 CFR 440.180, 441.300-.310	Form and Instruction
CMS-8003 Application for a sec. 1915(c) Home and Community-Based Application for 1915(c) HCBS Waiver Draft GU_11_00_00.mht	Form and Instruction

IC Title:

Home & Community Based Waiver Requests and Supporting Regulations; 42 CFR 440.180, 441.300-.310

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 440.180 42 CFR 441.300-310

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-8003	Application for a sec. 1915(c) Home and Community-Based Services Waiver	Application for 1915(c) HCBS Waiver Draft GU_11_00_00.mht		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 Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	71	0	71
Annual IC Time Burden (Hours)	6,005	-3,054	9,059
Annual IC Cost Burden (Dollars)	0	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.