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Annual Report on Home and Community-based Services Waivers

IC 43654 under ICR 202409-0938-022 · OMB 0938-0272.

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Document Name
Document Type
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Form
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Information Collection (IC) Details

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Annual Report on Home and Community-based Services Waivers
 
No Modified
 
Required to Obtain or Retain Benefits
 

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 Waiver Management System 372(S) Report Screenshots - 508.pdf Yes Yes Fillable Fileable
Form CMS-372(S) Annual Report Quality Section 372 Report Quality Section Updates (Screenshots).pdf Yes Yes Fillable Fileable

Health Health Care Services

 

47 0
   
State, Local, and Tribal Governments
 
   100 %

  Requested 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 259 0 0 6 0 253
Annual IC Time Burden (Hours) 11,396 0 0 264 0 11,132
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk 2021 to 2024 Form CMS-372(S) Report Crosswalk - Track Changes - Accepted.pdf 09/19/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.