Annual Report on Home and Community-based Services Waivers (CMS-372(S))

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-372(S) Annual Report Quality Section Prototype	Form	Modified	Available
Form CMS-372(S) Annual Report on Home and Community-Based Services (HCBS) Waivers	Form	Modified	Available
Form CMS-372(S) Annual Report on Home and Community-based Services Waivers	Form	Modified	Repair queued
CMS-372(S) - Supporting Statement A (2021 version 5).docx	Supporting Statement A	Uploaded 2021-10-21	Repair queued
Response to 60-Day Comments (2021 version 2).docx	Supplementary Document	Uploaded 2021-10-21	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43654	Annual Report on Home and Community-based Services Waivers	Form	Modified	Annual Report Quality Section Prototype
43654	Annual Report on Home and Community-based Services Waivers	Form	Modified	Annual Report on Home and Community-Based Services (HCBS) Waivers
43654	Annual Report on Home and Community-based Services Waivers	Form	Modified

ICR Details

OMB Control No: 0938-0272	ICR Reference No: 202110-0938-006
Status: Historical Active	Previous ICR Reference No: 201806-0938-008
Agency/Subagency: HHS/CMS	Agency Tracking No: CMCS
Title: Annual Report on Home and Community-based Services Waivers (CMS-372(S))
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/24/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/21/2021
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2024	36 Months From Approved	12/31/2021
Responses	253	0	282
Time Burden (Hours)	11,132	0	12,126
Cost Burden (Dollars)	0	0	0

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Abstract: States with an approved waiver under section 1915 (c) of the act are required to submit a report annually in order for CMS to: (1) Verify that State assurances regarding waiver cost-neutrality are met, and (2) determine the waiver's impact on the type, amount, and cost of services provided under the State Plan and health welfare of recipients.

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Authorizing Statute(s): Statute at Large: 19 Stat. 1915
   PL: Pub.L. 97 - 35 2176 Name of Law: Omnibus Budget Reconciliation Act of 1981
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 26921	05/18/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 57151	10/14/2021
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Annual Report on Home and Community-based Services Waivers	CMS-372(S), CMS-372(S)	Annual Report on Home and Community-Based Services (HCBS) Waivers ,   Annual Report Quality Section Prototype

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ICR Summary of Burden

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	253	282	0	-29	0	0
Annual Time Burden (Hours)	11,132	12,126	0	-994	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Changes to the online 372 reporting tool will be less of a burden for the states and CMS. The burden calculation includes a burden of hours increase by one hour for states. This results from changes to the quality section requiring data for all performance measures rather than only for health and welfare and deficient measures. States were already required to gather and evaluate data for each of the waiver’s performance measures on an annual basis, therefore the increase in burden of hours accounts for entering the additional information into the online 372 reporting tool. An additional burden decrease is associated with the full quality review conducted by CMS once per three- or five-year waiver cycle. When the online 372 reporting tool is updated to require data for each of the waiver’s approved performance measures on an annual basis, the overall burden of quality reporting will be reduced for the state. This is because the state will be providing the annual data for performance measures on a yearly rolling basis rather than partially with each Form CMS-372(S) Report and again for all performance measures once during the waiver cycle. This change will be less burden for CMS because the online 372 reporting tool will electronically pull the waiver’s approved performance measures into the report form for states to complete rather than CMS manually requesting it. Overall, we project a decrease of 29 responses (from 282 waivers to 253 waivers) and 994 hours ([Active: 282 waivers x 43 hr/response] – [Revised: [253 waivers x 44 hr/response]). When factoring the BLS’ wage increase of plus $5.04/hr (from $70.28/hr to $75.32/hr) we project a cost decrease of $13,753 (from $852,215 to $838,462).

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Annual Cost to Federal Government: $296,010

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/21/2021

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