Information Collection Request

HIV/AIDS Bureau Core Medical Services Waiver

ICR 201401-0915-001 · OMB 0915-0307 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
CMSwaiver legislation-Parts A-B-C_RW ExtenAct2009.doc Supplementary Document Uploaded 2014-01-28 Available
Supporting Statement.doc Supporting Statement A Uploaded 2014-01-28 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
181012 HIV/AIDS Bureau Core Medical Services Waiver Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2017 36 Months From Approved 04/30/2014
20 0 10
110 0 65
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
HIV/AIDS Bureau Core Medical Services Waiver

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 20 10 0 0 10 0
Annual Time Burden (Hours) 110 65 0 0 45 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No