HIV/AIDS Bureau Core Medical Services Waiver

⚠️ Notice: This information collection may be referencing outdated material.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.Core Medical Services Waiver Application.docx Instruction
CMSwaiver legislation-Parts A-B-C_RW ExtenAct2009.doc CMSwaiver legislation-Parts A-B-C_RW ExtenAct2009 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
Instruction			Form.Core Medical Services Waiver Application.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	20	10	10
Annual IC Time Burden (Hours)	110	45	65
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
CMSwaiver legislation-Parts A-B-C_RW ExtenAct2009	CMSwaiver legislation-Parts A-B-C_RW ExtenAct2009.doc	01/28/2014

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.