[Medicaid] Home & Community Based Waiver Requests and Supporting Regulations; 42 CFR 440.180 and 441.300 - 441.310 (CMS-8003)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-8003 Application for a Section 1915(c) Home and Community-Based Services Waiver	Form and Instruction	Modified	Available
Form CMS-8003 Home & Community Based Waiver Requests and Supporting Regulations; 42 CFR 440.180, 441.300-.310	Form and Instruction	Modified	Repair queued
1915(c) Waiver PRA Comments Summary with CMS Responses.pdf	Supplementary Document	Uploaded 2024-03-19	Repair queued
CMS-8003 - Supporting Statement A (2024 version 5).docx	Supporting Statement A	Uploaded 2024-03-19	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8072	Home & Community Based Waiver Requests and Supporting Regulations; 42 CFR 440.180, 441.300-.310	Form and Instruction	Modified	Application for a Section 1915(c) Home and Community-Based Services Waiver
8072	Home & Community Based Waiver Requests and Supporting Regulations; 42 CFR 440.180, 441.300-.310	Form and Instruction	Modified
8072	Home & Community Based Waiver Requests and Supporting Regulations; 42 CFR 440.180, 441.300-.310	Instruction	Modified

ICR Details

OMB Control No: 0938-0449	ICR Reference No: 202403-0938-010
Status: Historical Active	Previous ICR Reference No: 202312-0938-007
Agency/Subagency: HHS/CMS	Agency Tracking No: CMCS
Title: [Medicaid] Home & Community Based Waiver Requests and Supporting Regulations; 42 CFR 440.180 and 441.300 - 441.310 (CMS-8003)
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: 07/26/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/19/2024
Terms of Clearance: This subject matter contained in this collection is linked to the ICR package for CMCS 1115 waiver requests, OMB 0938-1148, but remains separate due to significant interest in public comment. OMB is approving this information collection request for a period of three years during which time the agency will request approval to extend or revise the collection if the agency seeks to continue the information collection activity beyond the period approved under this action.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2027	36 Months From Approved	02/28/2027
Responses	64	0	71
Time Burden (Hours)	5,332	0	6,005
Cost Burden (Dollars)	0	0	0

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Abstract: Under a Secretarial waiver, States may offer a wide array of home and community-based services to individuals who would otherwise require institutionalization. States requesting a waiver must provide certain assurances, documentation and cost & utilization estimates which are reviewed, approved and maintained for the purpose of identifying/verifying States' compliance with such statutory and regulatory requirements.

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Authorizing Statute(s): PL: Pub.L. 97 - 35 2176 Name of Law: Omnibus Budget Reconciliation Act (OBRA) 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:
	88 FR 62377	09/11/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 19314	03/18/2024
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
Home & Community Based Waiver Requests and Supporting Regulations; 42 CFR 440.180, 441.300-.310	CMS-8003	Application for a Section 1915(c) Home and Community-Based Services Waiver

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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	64	71	0	-7	0	0
Annual Time Burden (Hours)	5,332	6,005	0	-673	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: For new waivers, we have reduced the number of responses by 4, increased the time per response by 3 hours, and reduced the total time by 628 hours. For renewal applications, we have reduced the number of respondents by 33, reduced the number of responses by 3, increased the time per response by 3 hours, and reduced the total time by 45 hours. We have also revised our costs estimates to align with current BLS wage data.

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Annual Cost to Federal Government: $518,858

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: 03/19/2024

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