Annual Report on Home and Community-based Services Waivers

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

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form CMS-372(S) Annual Report on Home and Community-based Services Waivers Form
CMS-372(S) Annual Report on Home and Community-Based Services (HCBS Form CMS-372(S) Annual Report on Home and Community-Based Services (HCBS) Waivers Screenshots - 508.pdf Form
CMS-372(S) Annual Report on Home and Community-Based Services (HCBS Form CMS-372(S) Annual Report on Home and Community-Based Services (HCBS) Waivers Screenshots - 508.pdf Form
CMS-372(S) Annual Report Quality Section Prototype Form CMS-372(S) Annual Report on Home and Community-Based Services (HCBS) Waivers Quality Section Revision Prototype - 508.pdf Form
CMS-372(S) Annual Report Quality Section Prototype Form CMS-372(S) Annual Report on Home and Community-Based Services (HCBS) Waivers Quality Section Revision Prototype - 508.pdf Form
Form CMS-372(S) Annual Report on Home and Community-Based Services (HCBS) Waivers Crosswalk - 508.pdf Crosswalk IC Document
Form CMS-372(S) Annual Report on Home and Community-Based Services (HCBS) Waivers Crosswalk - 508.pdf Crosswalk IC Document

Information Collection (IC) Details

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-372(S)	Annual Report on Home and Community-Based Services (HCBS) Waivers	Form CMS-372(S) Annual Report on Home and Community-Based Services (HCBS) Waivers Screenshots - 508.pdf		Yes	Yes	Fillable Fileable
Form	CMS-372(S)	Annual Report Quality Section Prototype	Form CMS-372(S) Annual Report on Home and Community-Based Services (HCBS) Waivers Quality Section Revision Prototype - 508.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 48	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	253	-29	282
Annual IC Time Burden (Hours)	11,132	-994	12,126
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Crosswalk	Form CMS-372(S) Annual Report on Home and Community-Based Services (HCBS) Waivers Crosswalk - 508.pdf	10/21/2021

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