CMS-10831_Supporting Statement A (CMS-4201-P version 6)
CMS-10831_Supporting Statement A (CMS-4201-P version 6).docx
Transitional Coverage and Retroactive Medicare Part D Coverage for Certain Low-Income Beneficiaries through the Limited Income Newly Eligible Transition (LI NET) Program (CMS-10831)
OMB: 0938-1441
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-1441 can be found here: