Information Collection Request

Letter Requesting Waiver of Medicare/Medicaid Enrollment Application Fee; Submission of Fingerprints; Submission of Medicaid Identifying Information; Medicaid Site Visit and Rescreening

ICR 201010-0938-005 · OMB 0938-1137 · Historical Inactive

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
CMS-10357.Instrument Elements.doc Supplementary Document Uploaded 2010-10-20 Available
CMS-10357.Supporting Statement Part A.doc Supporting Statement A Uploaded 2010-10-20 Available

IC Document Collections

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
36 Months From Approved
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0 0 0
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Reginfo record details
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