Information Collection

Annual Report on Home and Community-based Services Waivers

IC 43654 under ICR 201806-0938-008 · OMB 0938-0272.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0272 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-372 Annual Report on Home and Community-based Services Waivers	Form and Instruction
CMS-372 Annual Report on Home and Community Based Waivers WMS_372_Report_Screenshots_508_Compliant.pdf	Form and Instruction
CMS-372 PRA Disclosure Statement and Exp Date: Annual Report on Screenshots of PRA Disclosure Statement and OMB number posted on the 372.pdf	Form and Instruction
372S_Crosswalk_508_Compliant (rev 06-29-2018 by OSORA PRA).pdf Crosswalk	IC Document

IC Title:

Annual Report on Home and Community-based Services Waivers

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:

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-372	Annual Report on Home and Community Based Waivers	WMS_372_Report_Screenshots_508_Compliant.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-372	PRA Disclosure Statement and Exp Date: Annual Report on Home and Community-Based Services Waivers	Screenshots of PRA Disclosure Statement and OMB number posted on the 372.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 47

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	Previously Approved
Annual Number of Responses for this IC	282	-33	315
Annual IC Time Burden (Hours)	12,126	-1,419	13,545
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Crosswalk	372S_Crosswalk_508_Compliant (rev 06-29-2018 by OSORA PRA).pdf	06/29/2018

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