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

ICR 202405-0938-028

OMB: 0938-1384

Federal Form Document

Forms and Documents

Document Name	Status
Form CMS-10752 Acute Hospital Care at Home Form and Instruction	Modified
Form CMS-10752 1135 Waiver Request Automated Process Form and Instruction	Modified
CMS 10752 .SupportingStatementPartA (30-day).docx Supporting Statement A	2024-05-31
CMS 10752 Non-Substantive Change_2023 Hurricane Idalia.docx Justification for No Material/Nonsubstantive Change	2023-08-29

IC Document Collections

IC ID	Document Title	Status
245795	Acute Hospital Care at Home Form and Instruction	Modified
243968	1135 Waiver Request Automated Process Form and Instruction	Modified