CMS-10615 HIP 2.0 Disenrollee and Lockout Beneficiary Survey (web

Healthy Indiana Program (HIP) 2.0 Beneficiary Focus Groups (CMS-10615)

6.DisenrolleeWebSurvey_v.2_0719ExpDate_508

Beneficiaries Survey

OMB: 0938-1300

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-1300 can be found here:

2018-07-05 - No material or nonsubstantive change to a currently approved collection

Document [pdf]

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File Type	application/pdf
File Title	Disenrollee Web Survey
Subject	Healthy Indiana Plan; HIP; Disenrollee Web Survey
Author	Centers for Medicare & Medicaid Services
File Modified	2016-09-28
File Created	2016-07-20