CMS-10680 EVV Personal Care Services (PCS) Survey

Personal Care Services

June 5, 2019

HCBS EVV State Compliance Survey Screenshots

PRA Disclosure Statement: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-TBD  (Expires: TBD).  This information collection is mandatory for states to complete in order to demonstrate compliance with section 1903(l) of the Social Security Act. States that are otherwise fully compliant with the requirements may experience Federal Medical Assistance Percentage (FMAP) reductions per section 1903(l)(1) of the Social Security Act if they do not complete this information collection. Under the Privacy Act of 1974 any personally identifying information obtained will be kept private to the extent of the law.  The time required to complete the information collection is estimated to average 130-150 minutes, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

 

Electronic Visit Verification Landing Page

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