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

ICR 202208-0938-003

OMB: 0938-1384

Federal Form Document

Forms and Documents
Form and Instruction
Form and Instruction
Justification for No Material/Nonsubstantive Change
Supporting Statement A
IC Document Collections
ICR Details
0938-1384 202208-0938-003
Active 202205-0938-012
Submissions of 1135 Waiver Request Automated Process (CMS-10752)
No material or nonsubstantive change to a currently approved collection   No
Approved without change 08/03/2022
Retrieve Notice of Action (NOA) 08/03/2022
  Inventory as of this Action Requested Previously Approved
05/31/2024 05/31/2024 05/31/2024
4,020 0 4,020
5,629 0 5,629
0 0 0

Waivers under Section 1135 of the Social Security Act (the Act) and certain flexibilities allow the CMS to relax certain requirements, known as the Conditions of Participation (CoPs) or Conditions of Coverage to promote the health and safety of beneficiaries. Under Section 1135 of the Act, the Secretary may temporarily waive or modify certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements to ensure that sufficient health care services are available to meet the needs of individuals enrolled in Social Security Act programs in the emergency area and time periods. These waivers ensure that providers who provide such services in good faith can be reimbursed and exempted from sanctions. During emergencies, such as the current COVID-19 public health emergency (PHE), CMS must be able to apply program waivers and flexibilities under section 1135 of the Social Security Act, in a timely manner to respond quickly to unfolding events. In a disaster or emergency, waivers and flexibilities assist health care providers/suppliers in providing timely healthcare and services to people who have been affected and enables states, Federal districts, and U.S. territories to ensure Medicare and/or Medicaid beneficiaries have continued access to care. During disasters and emergencies, it is not uncommon to evacuate Medicare-participating facilities and relocate patients/residents to other provider settings or across state lines, especially, during hurricane and tornado events. CMS must collect relevant information for which a provider is requesting a waiver or flexibility to make proper decisions about approving or denying such requests. Collection of this data aids in the prevention of gaps in access to care and services before, during, and after an emergency. CMS must also respond to inquiries related to a PHE from providers and beneficiaries. CMS is not collecting information from these inquiries; we are merely responding to them.

US Code: 42 USC 1812(f) Name of Law: Social Security Act
   US Code: 42 USC 1135 Name of Law: Social Security Act
   US Code: 42 USC 1320b-5 Name of Law: Social Security Act

Not associated with rulemaking

  85 FR 66990 10/21/2020
86 FR 10282 02/19/2021

IC Title Form No. Form Name
1135 Waiver Request Automated Process CMS-10752, CMS-10752 Waiver Inquiry Form ,   Helath Care Facility Status Collection Form
Acute Hospital Care at Home CMS-10752 Acute Hospital at Home

  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 4,020 4,020 0 0 0 0
Annual Time Burden (Hours) 5,629 5,629 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Subsequent to the Emergency information collection request, we are revising the package to include a second form, Healthcare Facility Status Workflow, which is for operational status information which will be used to assist providers in delivering critical care to beneficiaries during emergencies. The burden hours increased by 591 hours due to this additional form. We are also correcting a grammatical error from the previous submission. The total burden hours should have been 3,139 instead of 3,000. There were burden hours added as well which brought the total to 3,730. In addition to the changes mentioned earlier in this section, we are also adding 299 hours of burden to account for a violation of the Paperwork Reduction Act for the Acute Hospital Care at Home waiver initiative. We have provided burden for the violation as well as burden estimates for future efforts related to waiver which equate to 1,600 hours. The total burden hours for this ICR are 5,629 (3,730 + 299 + 1,600).

Denise King 410 786-1013 [email protected]


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:
    (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;
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.

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