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Acute Hospital Care at Home
Submissions of 1135 Waiver Request Automated Process (CMS-10752)
OMB: 0938-1384
IC ID: 245795
OMB.report
HHS/CMS
OMB 0938-1384
ICR 202409-0938-009
IC 245795
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1384 can be found here:
2024-10-08 - No material or nonsubstantive change to a currently approved collection
2024-09-25 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form CMS-10752
Acute Hospital Care at Home
Form and Instruction
CMS-10752 Acute Hospital at Home
CMS 10752 NEW (AHCAH)_PRA Revision 022924.pdf
Form and Instruction
CMS-10752 AHCAH Data Measures form
AHCAH Data Measures form.pdf
Form and Instruction
CMS-10752 AHCAH waiver
Acute Hospital Care at Home Waiver updated.pdf
Form and Instruction
CMS 10752 Crosswalk (AHCAH).pdf
Crosswalk - AHCAH
IC Document
Information Collection (IC) Details
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