Home & Community Based Waiver Requests and Supporting Regulations; 42 CFR 440.180, 441.300-.310 (CMS-8003)

Forms and Documents

Document Name	Status
Form CMS-8003 Home & Community Based Waiver Requests and Supporting Regulations; 42 CFR 440.180, 441.300-.310 Form and Instruction	Modified
Supporting Statement 1915(c) HCBS Revised Waiver Application 7.2008.sb.doc Supporting Statement A	2009-04-10

IC Document Collections

IC ID	Document Title	Status
8072	Home & Community Based Waiver Requests and Supporting Regulations; 42 CFR 440.180, 441.300-.310 Form and Instruction	Modified

ICR Details

OMB Control No: 0938-0449	ICR Reference No: 200904-0938-013
Status: Historical Active	Previous ICR Reference No: 200809-0938-016
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Home & Community Based Waiver Requests and Supporting Regulations; 42 CFR 440.180, 441.300-.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: 07/24/2009
	Date Received in OIRA: 04/23/2009
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2012	36 Months From Approved	12/31/2011
Responses	71	0	136
Time Burden (Hours)	9,059	0	8,010
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:
	74 FR 3051	01/16/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 17870	04/17/2009
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

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 1915(c) Home and Community Based Waiver

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ICR Summary 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	71	136	0	-65	0	0
Annual Time Burden (Hours)	9,059	8,010	0	1,049	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The increase is directly related to the increased information requested in the revised waiver application. As indicated in the 2003 GAO report and in correspondence from Senators Grassley and Breaux, CMS needed to improve its familiarity and oversight of these programs that serve vulnerable citizens. The increased information not only makes the program design proposed by the State transparent to CMS, it also provides a document for use by the public that explains the waiver program, including persons and geographical areas served, services offered, individual rights and, importantly, the mechanisms used by the State to meet all of the statutory requirements of the 1915(c) waiver program.

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Annual Cost to Federal Government: $648,620

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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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: 04/23/2009

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