Crosswalk CMS-1763 OMB 00938-0025 Crosswalk Changes.xlsx Request for Termination of Premium-Hospital and or Supplementary Medical Insurance and Supporting Regulations in 42 CFR 406.13 and 407.27 (CMS-1763) Crosswalk OMB: 0938-0025
OMB.report
HHS/CMS
OMB 0938-0025
ICR 201712-0938-010
Crosswalk
( Supplementary Document )
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2017 (old version) 2018 (new version) Type of Change Reason for Change Burden Change
Medicare Claim Number Medicare Number Rev Terminology change for consistent terminology for the new Medicare number as part of the statutory requirement under the Medicare Access and CHIP Reauthorization Act of 2015. No
(Yes or No. Postitive response should explain.)
File Type application/vnd.openxmlformats-officedocument.spreadsheetml.sheet File Modified 0000-00-00 File Created 0000-00-00