Mock-up

CMS 10752 Mock-Up 1135 Waiver-Inquiry Collection Instrument (2024 Hurricane Francine).pdf

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

Mock-up

OMB: 0938-1384

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-1384 can be found here:

2025-07-09 - No material or nonsubstantive change to a currently approved collection
2025-01-10 - No material or nonsubstantive change to a currently approved collection

Document [pdf]

Download: pdf | pdf

1135 Web Portal PHE Change

Add PHE to drop-down list:
2024 Hurricane Francine
XX/XX/XXXX – XX/XX/XXXX

https://cmsqualitysupport.servicenowservices.com/cms_1135

File Type	application/pdf
Author	Saunders, Adriane (CMS/CCSQ)
File Modified	2024-09-12
File Created	2024-09-12