HHS Qualifying Clinical Trial Attestation Form
[Medicaid] Generic Clearance for Medicaid and CHIP State Plan, Waiver, and Program Submissions (CMS-10398)
REVISED QUALIFYING CLINICAL TRIAL ATTESTATION FORM Clean 3.17.22 - 508
GenIC #74 (Revised): 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⚠️ Notice: This form may be outdated.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: