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Form CMS-10840 CMS Model Consent Form for Marketplace Agents and Broker
Supporting Statement for Agent/Broker Consent Information Collection (CMS-10840)
CMS-10840_Agent-Broker_Consent_Appenidx_A_Consent_Form
Agent/Broker Consent
OMB: 0938-1438
OMB.report
HHS/CMS
OMB 0938-1438
ICR 202301-0938-001
IC 257714
Form CMS-10840 CMS Model Consent Form for Marketplace Agents and Broker
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-1438 can be found here:
2023-04-27 - New collection (Request for a new OMB Control Number)
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