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

ICR 202507-0938-014

OMB: 0938-1384

Federal Form Document

Forms and Documents

Document Name	Status
Form CMS-10752 Acute Hospital Care at Home Form and Instruction	Unchanged
Form CMS-10752 1135 Waiver Request Automated Process Form and Instruction	Unchanged
CMS 10752 NEW 1135 Waiver-Inquiry Collection Instrument (2025 Texas Flooding).pdf Supplementary Document	2025-07-09
CMS 10752 Mock-Up 1135 Waiver-Inquiry Collection Instrument (2025 Texas Flooding).pdf Supplementary Document	2025-07-09
CMS 10752 1135 Waiver_Flexibility Request and 1135 Inquiry Form Revision Table - 2025 Texas Flooding.docx Supplementary Document	2025-07-09
CMS 10752 Non-Substantive Change_2025 Texas Flooding.docx Justification for No Material/Nonsubstantive Change	2025-07-09
CMS 10752 .SupportingStatementPartA (30-day) 080824 CLEAN FINAL.docx Supporting Statement A	2024-08-09

IC Document Collections

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