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Form CMS-10816 Informed Consent
Medicare Part C and Medicare Part D Enrollment Form Interviews (CMS-10816)
Attachment D - Informed Consent Form CMS-10816_508
Interview Guide
OMB: 0938-1440
OMB.report
HHS/CMS
OMB 0938-1440
ICR 202211-0938-013
IC 257119
Form CMS-10816 Informed Consent
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-1440 can be found here:
2023-12-08 - No material or nonsubstantive change to a currently approved collection
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