Qualifying Clinical Trial Attestation Form
[Medicaid] Generic Clearance for Medicaid and CHIP State Plan, Waiver, and Program Submissions (CMS-10398)
74 - QUALIFYING CLINICAL TRIAL ATTESTATION FORM CLEAN 8.17.21 I
#74 (New): Coverage of Routine Patient Cost for Items & Services in Qualifying Clinical Trials
OMB: 0938-1148
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-1148 can be found here: