Notice of Denial of Medical Coverage (or Payment) (NDMCP) (CMS-10003)

ICR 202211-0938-002

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-0829 can be found here:

Forms and Documents

Document Name	Status
Form CMS-10003 Notice of Denial of Medical Coverage (or Payment) Form	Modified
CMS-10003 - Supporting Statement A_clean508.docx Supporting Statement A	2022-11-16

IC Document Collections

IC ID	Document Title	Status
8626	Notice of Denial of Medical Coverage (or Payment) Form	Modified

ICR Details