Document
CMS-R-0282 Sample Form
ICR 201910-0938-007 · OMB 0938-0778 · Object 95920701.
This document may belong to an older filing. More recent activity for OMB 0938-0778:
Document Viewer [pdf]
Status: No verified local artifact is currently available. The document remains flagged for repair and upstream re-check.
Queue: Repair is queued and waiting for the next worker pass. (priority 140 · next 2026-06-06 07:47:12)
Missing: pdf
No local or Spaces-backed artifact is available yet for this document.
Loading document viewer…
Document Metadata
| File Type | application/octet-stream |
|---|---|
| File Title | CMS-R-0282 Sample Form |
| Subject | Sample Form for MA Appeals and Grievances |
| Author | CMS/CPC/MEAG/DAP |
| File Modified | 2019-07-11 |
| File Created | 2019-07-11 |
| Conversion State | failed_conversion |