Any request under this chapter shall contain, at a minimum, all of the following:
(a) The regulation or regulations for which the county requests a waiver.
(b) A statement as to why the identified regulation or regulations should be waived.
(c) A statement as to why the identified regulation or regulations inhibit the efficient administration of the program.
(d) A comparison of the following:
(1) The services and the number of persons to be served under the requested waiver.
(2) The services and the number of persons to be served without the requested waiver.
(e) Projected costs or savings due to the requested waiver.
(f) Any impact on state and federal funding.