Crosswalk - Waiver Flexibility Request

CMS 10752 1135 Waiver_Flexibility Request and 1135 Inquiry Form Revision Table - County Field_Rev. 090822.pdf

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

Crosswalk - Waiver Flexibility Request

OMB: 0938-1384

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

Page #
2

Section
Describe your
Waiver and
Flexibility

Action to be
performed
Updated
Content (0907-2022)

Changes to the Application

Reason for the Change

Added 2 required drop downs that will display when a

Enhancement

customer selects a conditional blanket waiver:
-

State/US Territory/Federal District
County

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

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