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Form CMS-10797 CMS 10797 Application for Part A and Part B Special Enro
Application For Medicare Part A and Part B Special Enrollment Period (Exceptional Circumstances) (CMS-10797)
CMS 10797 Application for Part A and Part B Special Enrollment Period Exceptional Circumstances_508
Application For Medicare Part A and Part B Special Enrollment Period (Exceptional Circumstances)
OMB: 0938-1426
OMB.report
HHS/CMS
OMB 0938-1426
ICR 202210-0938-009
IC 254496
Form CMS-10797 CMS 10797 Application for Part A and Part B Special Enro
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-1426 can be found here:
2025-03-28 - Reinstatement with change of a previously approved collection
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