1135 Waiver Request Automated Process

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

OMB: 0938-1384

IC ID: 243968

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