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CMS-10797 - Supporting Statement A (CMS-4199-F version 11.1)
CMS-10797 - Supporting Statement A (CMS-4199-F version 11.1).docx
Application For Medicare Part A and Part B Special Enrollment Period (Exceptional Circumstances) (CMS-10797)
OMB: 0938-1426
OMB.report
HHS/CMS
OMB 0938-1426
ICR 202210-0938-009
CMS-10797 - Supporting Statement A (CMS-4199-F version 11.1)
( Supporting Statement A )
⚠️ Notice: This form may be outdated.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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