Supporting Statement for Agent/Broker Consent Information Collection (CMS-10840)

ICR 202301-0938-001

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1438 can be found here:

Forms and Documents

Document Name	Status
Form CMS-10840 Agent/Broker Consent Form	New
CMS-10840_Agent-Broker_Consent_Supporting_Statement.docx Supporting Statement A	2023-01-04

IC Document Collections

IC ID	Document Title	Status
257714	Agent/Broker Consent Form	New

ICR Details