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| 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 | 72x 1x 1x 1x 1x | import { ActionForm } from "@/components/ActionForm";
import { PackageSection } from "@/components/Form/content/PackageSection";
import { formSchemas } from "@/formSchemas";
import { useParams } from "react-router";
export const WithdrawRaiForm = () => {
const { authority, id } = useParams();
const faqLink = authority?.includes("SPA")
? authority?.includes("CHIP")
? "chip-spa"
: "spa"
: "waiver";
const authorityText = authority === "1915(c)" ? `1915(c) Appendix K` : authority;
return (
<ActionForm
schema={formSchemas["withdraw-rai"]}
title={`${authorityText} Withdraw Formal RAI Response Details`}
fields={() => <PackageSection />}
defaultValues={{
id,
authority,
}}
attachments={{
faqLink: `/faq/withdraw-${faqLink}-rai-response`,
}}
documentPollerArgs={{
property: "id",
documentChecker: (check) => check.recordExists,
}}
breadcrumbText="Withdraw Formal RAI Response"
formDescription="Complete this form to withdraw the Formal RAI response. Once complete,
you and CMS will receive an email confirmation."
preSubmissionMessage="Once complete, you and CMS will receive an email confirmation."
bannerPostSubmission={{
header: "Withdraw Formal RAI Response request has been submitted.",
body: "Your Formal RAI Response has been withdrawn successfully. If CMS needs any additional information, they will follow up by email.",
variant: "success",
}}
additionalInformation={{
required: true,
title: "Additional Information",
label: "Explain your need for withdrawal.",
}}
promptPreSubmission={{
header: "Withdraw Formal RAI response?",
body: `You are about to withdraw the Formal RAI Response for ${id}. CMS will be notified.`,
acceptButtonText: "Yes, withdraw response",
cancelButtonText: "Cancel",
}}
/>
);
};
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