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Home & Community Based Waiver Requests and Supporting Regulations; 42 CFR 440.180, 441.300-.310
Home & Community Based Waiver Requests and Supporting Regulations; 42 CFR 440.180 and 441.300 - 441.310 (CMS-8003)
OMB: 0938-0449
IC ID: 8072
OMB.report
HHS/CMS
OMB 0938-0449
ICR 202312-0938-007
IC 8072
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0449 can be found here:
2024-07-31 - No material or nonsubstantive change to a currently approved collection
2024-03-19 - Revision of a currently approved collection
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
Instructions_TechnicalGuide_V3.6 revised 12-30-21.pdf
Instruction
Instructions_TechnicalGuide_V3.6 revised 12-30-21.pdf
Instruction
CMS-8003 Application for a Section 1915(c) Home and Community-Bas
Waiver Application (2022 version 2).pdf
Form and Instruction
CMS-8003 Application for a Section 1915(c) Home and Community-Bas
Waiver Application (2022 version 2).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 Section 1915(c) Home and Community-Based Services Waiver
Waiver Application (2022 version 2).pdf
Yes
Yes
Fillable Fileable
Instruction
Instructions_TechnicalGuide_V3.6 revised 12-30-21.pdf
No
Printable Only
Federal Enterprise Architecture Business Reference Module
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
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
71
0
0
0
0
71
Annual IC Time Burden (Hours)
6,005
0
0
0
0
6,005
Annual IC Cost Burden (Dollars)
0
0
0
0
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.