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CMS-10003 - Supporting Statement A_clean508
CMS-10003 - Supporting Statement A_clean508.docx
Notice of Denial of Medical Coverage (or Payment) (NDMCP) (CMS-10003)
OMB: 0938-0829
OMB.report
HHS/CMS
OMB 0938-0829
ICR 202211-0938-002
CMS-10003 - Supporting Statement A_clean508
( Supporting Statement A )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-0829 can be found here:
2023-08-08 - Extension without change of a currently approved collection
2023-03-02 - No material or nonsubstantive change to a currently approved collection
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