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Form CMS-10275 Participation Exemption Request (PER) Form
CAHPS Home Health Care Survey (CMS-10275)
Participation Exemption Request Form.mht
Participation Exemption Request (PER) Form
OMB: 0938-1066
OMB.report
HHS/CMS
OMB 0938-1066
ICR 201705-0938-013
IC 210204
Form CMS-10275 Participation Exemption Request (PER) Form
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-1066 can be found here:
2023-03-31 - Extension without change of a currently approved collection
2020-05-14 - Extension without change of a currently approved collection
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