Crosswalk table of Waiver Inquiry Form - KY Flooding

CMS 10752 1135 Waiver_Flexibility Request and 1135 Inquiry Form Revision Table - KY Flooding.pdf

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

Crosswalk table of Waiver Inquiry Form - KY Flooding

OMB: 0938-1384

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-1384 can be found here:

2023-08-29 - No material or nonsubstantive change to a currently approved collection
2023-08-14 - No material or nonsubstantive change to a currently approved collection

Document [pdf]

Download: pdf | pdf

Revisions to 1135 Waiver Request Webform
Issue #
1.
2.

Page #

Section

2, 5, 7, 9, 11,
13

Drop Down
Options

3,5,7,9,11,13

Drop Down
Options Info

Action to be
performed
Updated
Content (0802-2022)
Updated
Content (0802-2022)

Changes to the Application

Reason for the Change

Added new PHE to Drop Down Info section: Kentucky

Updated Drop Down options

Added new PHE to Drop Down Info section: New

Updated Drop Down Info

Flooding xx/xx/xxxx – xx/xx/xxxx

Kentucky Flooding xx/xx/xxxx – xx/xx/xxxx

File Type	application/pdf
Author	Alexander Rooke
File Modified	2022-08-03
File Created	2022-08-03