Billing Code: 4165-15-P

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
Agency Information Collection Activities: Submission to OMB for Review and Approval;
Public Comment Request; Ryan White HIV/AIDS Program Core Medical Services Waiver
Form
AGENCY: Health Resources and Services Administration (HRSA), Department of Health and
Human Services.
ACTION: Notice.
SUMMARY: In compliance with the Paperwork Reduction Act of 1995, HRSA submitted an
Information Collection Request (ICR) to the Office of Management and Budget (OMB) for
review and approval. Comments submitted during the first public review of this ICR will be
provided to OMB. OMB will accept further comments from the public during the review and
approval period. OMB may act on HRSA’s ICR only after the 30-day comment period for this
notice has closed.
DATES: Comments on this ICR should be received no later than [INSERT DATE 30 DAYS
AFTER DATE OF PUBLICATION IN THE FEDERAL REGISTER]. The form will become
effective on October 1, 2024.
ADDRESSES: Written comments and recommendations for the proposed information
collection should be sent within 30 days of publication of this notice to
www.reginfo.gov/public/do/PRAMain. Find this particular information collection by selecting
"Currently under Review - Open for Public Comments" or by using the search function.
FOR FURTHER INFORMATION CONTACT: To request a copy of the clearance requests
submitted to OMB for review, email Joella Roland, the HRSA Information Collection Clearance
Officer, at paperwork@hrsa.gov or call (301) 443-3983.

SUPPLEMENTARY INFORMATION:
Information Collection Request Title: Ryan White HIV/AIDS Program Core Medical
Services Waiver Form, OMB No. 0906-0065  Revision
Abstract: In accordance with sections 2604(c), 2612(b), and 2651(c) of the Public Health
Service Act, recipients are required to spend not less than 75 percent of funds on core medical
services for individuals identified with HIV and who are eligible under the statute, after
reserving permissible amounts for administrative and clinical quality management (CQM) costs.
The statute also grants the Secretary authority to waive this requirement for a Ryan White
HIV/AIDS Program (RWHAP) Part A, B, or C recipient if certain requirements are met, and a
waiver request is submitted to HRSA for approval.
As currently implemented by HRSA, in order to be approved, (1) core medical services
must be available and accessible to all individuals identified and eligible for the RWHAP in the
recipient’s service area within 30 days. This access must be without regard to payer source, and
without the need to spend at least 75 percent of funds remaining from the recipient’s RWHAP
award after statutorily permissible amounts for administrative and CQM costs are reserved; (2)
the recipient must ensure there are no AIDS Drug Assistance Program (ADAP) waiting lists in
its service area; and (3) a public process to obtain input on the waiver request must have
occurred. This process must seek input from impacted communities, including clients and
RWHAP-funded core medical services providers, on the availability of core medical services,
and the decision to request the waiver. The public process may be a part of the same one used by
recipients to seek input on community needs as part of the annual priority setting and resource
allocation, comprehensive planning, statewide coordinated statement of need, public planning,
and/or needs assessment processes. RWHAP Parts A, B, and C core medical services waiver
requests must include funds awarded under the Minority AIDS Initiative. Core medical services
waivers are effective for a 1-year period.
The process for RWHAP Parts A, B, and C grant recipients to request a waiver of the

minimum expenditure amount requirements for core medical services is outlined in Policy
Notice 21-01, Waiver of the Ryan White HIV/AIDS Program Core Medical Services
Expenditure Requirement. Policy Notice 21-01 is currently being revised and will be effective
October 1, 2024.
HRSA proposes to modify the one-page form to include the proposed percentages of HIV
service dollars allocated to core medical and support services. Under the proposed changes, a
field will be added to the form to capture the proposed percentages. This information will
inform HRSA whether recipients are able to meet the statutory requirements in sections 2604(c),
2612(b), and 2651(c) of the Public Health Service Act and will clarify what proposed portion of
funds will be allocated to core medical and support services. Minor changes will also be made to
the form to increase readability.
Summary of Proposed Changes: Sections 2604(c), 2612(b), and 2651(c) of the Public
Health Service Act require recipients to spend not less than 75 percent of funds on core medical
services after reserving statutorily permissible amounts for administrative and CQM costs.
However, on the current version of the form, the portion of HIV service dollars to be allocated to
core medical and support services was sometimes unclear. The suggested change to the form
adds a requirement to include the proposed percentages of HIV service dollars allocated to core
medical and support services. The table on the current form is expanded to allow for the
insertion of the proposed percentages for core medical and support services. Instructions at the
top of the new form are updated to indicate where to insert the proposed percentages. Language
within the table is also updated to increase readability.
The proposed changes do not modify the underlying requirements necessary to obtain a
waiver: all core medical services are available and accessible within 30 days in the jurisdiction or
service area; ensuring that the state ADAP has no waiting lists; and that the recipient has used a
public process to determine the need for a waiver. Recipients may still need to provide
supportive evidence to HRSA upon request.

A 60-day notice published in the Federal Register on February 27, 2024, vol. 89, No. 39;
pp. 14507-14508. There were no public comments.
Need and Proposed Use of the Information: HRSA uses the documentation submitted in
core medical services waiver requests to determine if the RWHAP Parts A, B, and C grant
applicant or recipient meets the statutory requirements for waiver eligibility including: (1) no
waiting lists for ADAP services; and (2) evidence of core medical services availability within the
grant recipient’s jurisdiction, state, or service area to all persons identified with HIV and eligible
under Title XXVI of the Public Health Service Act.
Likely Respondents: HRSA expects responses from RWHAP Parts A, B, and C grant
applicants and recipients. The number of grant recipients requesting waivers fluctuates annually
and has ranged up to 23 per year since its implementation in fiscal year 2007. In light of recent
trends, HRSA anticipates receiving possibly up to 23 applications in a given year.

Burden Statement: Burden in this context means the time expended by persons to generate,
maintain, retain, disclose, or provide the information requested. This includes the time needed to
review instructions; to develop, acquire, install, and utilize technology and systems for the
purpose of collecting, validating, and verifying information, processing and maintaining
information, and disclosing and providing information; to train personnel and to be able to
respond to a collection of information; to search data sources; to complete and review the
collection of information; and to transmit or otherwise disclose the information. The total annual
burden hours estimated for this ICR are summarized in the table below.

Total Estimated Annualized Burden Hours:

Form Name

Number of
Respondents

Number of
Responses per
Respondent

Total
Responses

Average
Burden per
Response
(in hours)

Total
Burden
Hours

RWHAP Core
medical
Services Waiver
request
Attestation
Form
Total

1

23

0.49

11.27

11.27

HRSA specifically requests comments on (1) the necessity and utility of the proposed
information collection for the proper performance of the agency’s functions, (2) the accuracy of
the estimated burden, (3) ways to enhance the quality, utility, and clarity of the information to be
collected, and (4) the use of automated collection techniques or other forms of information
technology to minimize the information collection burden.

Maria G. Button,
Director, Executive Secretariat.
[FR Doc. 2024-13857 Filed: 6/24/2024 8:45 am; Publication Date: 6/25/2024]