Information Collection Request
Submissions of 1135 Waiver Request Automated Process (CMS-10752)
ICR 202306-0938-001 · OMB 0938-1384 · Active
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1384 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10752 Acute Hospital Care at Home |
Form and Instruction | Unchanged | Available |
| Form CMS-10752 1135 Waiver Request Automated Process |
Form and Instruction | Modified | Available |
 CMS 10752 Non-Substantive Change_2023 Typhoon Mawar_May.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2023-06-01 | Available |
| CMS 10752 Supporting Statement final 2-19-21.docx |
Supporting Statement A | Uploaded 2021-02-19 | Available |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 245795 |  Acute Hospital Care at Home |
Form and Instruction | Unchanged | |
| 243968 | 1135 Waiver Request Automated Process |
Form and Instruction | Modified |
ICR Details
| Status | Active |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1384 |
| Type of Information Collection | No material or nonsubstantive change to a currently approved collection |
| Previous ICR Reference No | 202303-0938-012 |
| Agency Tracking No | CCSQ |
| Date Submitted to OIRA | 2023-06-01 |
| Requested Expiration Date | 1969-12-31 |