OMB.report

Federal forms, ICRs, and supporting documents

Document

CMS-R-0282 Sample Form

ICR 201607-0938-014 · OMB 0938-0778 · Object 66679402.

Document Viewer [docx]

Status: Original and derived artifacts are available for this document.

Download: docx | pdf | html

Primary: docxSource: application/octet-stream
Loading document viewer…

Document Metadata

Record metadata
File Typeapplication/octet-stream
File TitleCMS-R-0282 Sample Form
SubjectSample Form for MA Appeals and Grievances
KeywordsMedicare, Advantage, sample, appeals, grievances, MA
AuthorCMS/CPC/MEAG/DAP
Last Modified ByWriter
File Modified2017-01-18
File Created2026-09-27
Conversion Statecomplete