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Medicare Managed Care Disenrollment Form

IC 8127 under ICR 200306-0938-010 · OMB 0938-0507.

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Medicare Managed Care Disenrollment Form
 
No Migrated
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-566 No No


    

85,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 85,000 0 0 0 0 85,000
Annual IC Time Burden (Hours) 2,805 0 0 0 0 2,805
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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