Form CMS-10752 Waiver Inquiry Form

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

CMS 10752 NEW 1135 Waiver-Inquiry Collection Instrument (Hurricane Fiona)

1135 Waiver Request Automated Process

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⚠️ Notice: This form may be outdated.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]

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CMS 1135 Waiver / Flexibility Request and Inquiry Form

Organization Workflow
CMS 1135 Waiver / Flexibility Request

File Type	application/pdf
File Modified	2022-09-21
File Created	2022-09-21

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