Crosswalk for Templates: IMD, ICF IID, PRTF, Clinic, and Physician
II PRA_NOV2021_Template Changes Crosswalk_#24.xlsx
[Medicaid] Generic Clearance for Medicaid and CHIP State Plan, Waiver, and Program Submissions (CMS-10398)
Crosswalk for Templates: IMD, ICF IID, PRTF, Clinic, and Physician
OMB: 0938-1148
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-1148 can be found here: