1135 Waiver Request Automated Process

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

OMB: 0938-1384

IC ID: 243968

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for 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

Documents and Forms

Document Name Document Type
Form CMS-10752 1135 Waiver Request Automated Process Form and Instruction
CMS-10752 Waiver Inquiry Form CMS 10752 NEW 1135 Waiver-Inquiry Collection Instrument (2023 Typhoon Mawar).pdf Form and Instruction
CMS-10752 Helath Care Facility Status Collection Form Health Care Facility Status Collection Instrument 2-9-21.pdf Form and Instruction
CMS 10752 Mock-Up of Previous 1135-Waiver-Inquiry Collection Instrument (2023 Typhoon Mawar).pdf Track change - Waiver flexibility request IC Document
CMS 10752 1135 Waiver_Flexibility Request and 1135 Inquiry Form Revision Table - 2023 Typhoon Mawar.docx Crosswalk - Waiver Flexibility Request IC Document

Information Collection (IC) Details

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