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1135 Waiver Request Automated Process
Submissions of 1135 Waiver Request Automated Process (CMS-10752)
OMB: 0938-1384
IC ID: 243968
OMB.report
HHS/CMS
OMB 0938-1384
ICR 202409-0938-027
IC 243968
( )
⚠️ Notice: This information collection may be referencing outdated material.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
Documents and Forms
Document Name
Document Type
Form CMS-10752
1135 Waiver Request Automated Process
Form and Instruction
CMS-10752 Waiver Inquiry Form
CMS 10752 NEW_PRA 1135 Revision.pdf
Form and Instruction
CMS 10752 Mock-Up_PRA 1135 Revision.pdf
Track change - Waiver flexibility request
IC Document
CMS 10752 Crosswalk (HCF)_PRA Revision.pdf
Crosswalk -1135 Web Portal (Health Care Facility portion)
IC Document
Information Collection (IC) Details
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