Non-substantive change request justification

CMS 10752 Non-Substantive Change.pdf

Submissions of 1135 Waiver Request Automated Process (CMS-10752)

Non-substantive change request justification

OMB: 0938-1384

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Non-Substantive Change Request to 0938-1384: Submissions of 1135 Waiver Request
Automated Process
September 7, 2021
This is a non-substantive change request to the CMS 1135 Waiver/Flexibility Request from the
‘Submission of 1135 Waiver Request Automated Process’ that was approved as OMB number
0938-1384. CMS must be able to apply waivers and flexibilities to assist health care
providers/suppliers in providing timely healthcare and services as well as ensure beneficiaries
have continued access to care during a disaster or emergency. Accordingly, CMS developed a
publically-accessible web based form to create a standardized, user-friendly submission that’s a
more efficient processing of 1135 waiver requests.
Last week (Week of August 30th), Hurricane Ida negatively impacted the north eastern United
States. As a result, the Secretary of Health and Human Services declared a “Public Health
Emergency” (PHE) for additional States. Therefore, CMS is requesting approval of the
following update effective September 7, 2021 to allow the agency to quickly provide necessary
assistance to those impacted by Hurricane Ida:
CMS 1135 Waiver/Flexibility Request web page
• Update the Public Health Emergency (PHE) on pages 2 and 3, such that “2021 Hurricane
Ida” is revised in the drop-down values to allow for use by multiple States for the “Select
a Public Health Emergency” section of the web form
CMS 1135 Inquiry web page
• Update the Public Health Emergency (PHE) on page 5, such that “2021 Hurricane Ida” is
revised in the drop-down values to allow for use by multiple States for the “Select a
Public Health Emergency” section of the web form
These changes have no impact on the previously stated burden associated with this collection.

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File Typeapplication/pdf
AuthorBen Walker
File Modified2021-09-07
File Created2021-09-07

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