1135 Waiver_Flexibility Request and 1135 Inquiry Form Revision Table - NM Wildfires

CMS 10752 1135 Waiver_Flexibility Request and 1135 Inquiry Form Revision Table - NM Wildfires.pdf

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

1135 Waiver_Flexibility Request and 1135 Inquiry Form Revision Table - NM Wildfires

OMB: 0938-1384

Document [pdf]
Download: pdf | pdf
Revisions to 1135 Waiver Request Webform
Issue #
1.

2.

3.

Page #

Section

2,5,7,9,11,13 Select a Public
Health Emergency
3,5,7,9,11,13 Drop Down
Options

2,5,7,9,11,13 Footer

Action to be
performed
Updated
Content (0506-2022)

Changes to the Application

Reason for the Change

Added new PHE to dropdown: New Mexico Wildfires

Update PHE drop down

Updated
Content (0506-2022)

Added new PHE to Drop Down Info section: New Mexico

Updated
Content (0506-2022)

xx/xx/xxxx – xx/xx/xxxx (Actuals dates will be applied as
defined in the PHE declaration by the Secretary of HHS)

Updated Drop Down Info

Wildfires xx/xx/xxxx – xx/xx/xxxx (Actuals dates will be

applied as defined in the PHE declaration by the Secretary
of HHS)
Added new footer content: To report technical issues

please email [email protected] and note “1135
Waiver/Flexibility” in the subject line.

If you are requesting an 1135 waiver or making an

Inquiry about a public health emergency, please submit

your request at the CMS PHE Emergency Web Portal. For
all other questions, please

contact [email protected].

Updated footer area


File Typeapplication/pdf
AuthorAlexander Rooke
File Modified2022-05-09
File Created2022-05-09

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