Information Collection Request
Supplemental to Form CMS-2552-10, Payment Adjustment for Domestic NIOSH-Approved Surgical N95 Respirators (CMS-10821)
ICR 202212-0938-003 · OMB 0938-1425 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10821 Supplemental to Form CMS-2552-10, Payment Adjustment for Domestic NIOSH-Approved Surgical N95 Respirators |
Form | Modified | Repair queued |
 CMS-10821.Supporting Statement Part A (final rule).docx |
Supporting Statement A | Uploaded 2022-12-02 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 254942 |  Supplemental to Form CMS-2552-10, Payment Adjustment for Domestic NIOSH-Approved Surgical N95 Respirators |
Form | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1425 |
| Type of Information Collection | New collection (Request for a new OMB Control Number) |
| Previous ICR Reference No | 202207-0938-017 |
| Agency Tracking No | CM-FFS |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |