Information Collection Request
Medicare Part C and Medicare Part D Enrollment Form Interviews (CMS-10816)
ICR 202211-0938-013 · OMB 0938-1440 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1440 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10816 Interview Guide |
Form and Instruction | New | Repair queued |
| Form CMS-10816 Invitation & Screening |
Form and Instruction | New | Repair queued |
 CMS-10816 - Supporting Statement A.docx |
Supporting Statement A | Uploaded 2022-11-29 | Repair queued |
| CMS-10816 - Supporting Statement B.docx |
Supporting Statement B | Uploaded 2022-11-28 | Repair queued |
| CMS Response to CMS-10816 60-day Public Comments 11.14.22 Final.docx |
Supplementary Document | Uploaded 2022-11-28 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 257119 |  Interview Guide |
Form and Instruction | New | |
| 257116 | Invitation & Screening |
Form and Instruction | New |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1440 |
| Type of Information Collection | New collection (Request for a new OMB Control Number) |
| Agency Tracking No | CMC-CPC |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |