Crosswalk: Waiver Flexibility Request Form

CMS 10752 1135 Waiver_Flexibility Request Form Revision Table - County Field.pdf

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

Crosswalk: Waiver Flexibility Request Form

OMB: 0938-1384

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

Page #
2

Section
Added new drop
down in
Organization
Information
section

Action to be
performed
Updated
Content (0805-2022)

Changes to the Application

Reason for the Change

Added required ‘County’ drop down field to Organization

Updated Organization Information
section with ‘County’ drop down

Information section on waiver form


File Typeapplication/pdf
AuthorAlexander Rooke
File Modified2022-08-10
File Created2022-08-09

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