Information Collection

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

IC 8072 under ICR 201702-0938-023 · 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⚠️ Notice: This information collection may be referencing outdated material.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

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 HCBSWaiverApp-v3 [rev Feb 2017].pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

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:

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	HCBSWaiverApp-v3 [rev Feb 2017].pdf		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 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	71	71
Annual IC Time Burden (Hours)	6,005	6,005
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.