Supplemental to Form CMS-2552-10, Payment Adjustment for Domestic NIOSH-Approved Surgical N95 Respirators (CMS-10821)

ICR 202212-0938-003

OMB: 0938-1425

Federal Form Document

Forms and Documents

Document Name	Status
Form CMS-10821 Supplemental to Form CMS-2552-10, Payment Adjustment for Domestic NIOSH-Approved Surgical N95 Respirators Form	Modified
CMS-10821.Supporting Statement Part A (final rule).docx Supporting Statement A	2022-12-02

IC Document Collections

IC ID	Document Title	Status
254942	Supplemental to Form CMS-2552-10, Payment Adjustment for Domestic NIOSH-Approved Surgical N95 Respirators Form	Modified