Initial Request for State Implemented Moratorium Form (CMS-10628)

ICR 202301-0938-007

OMB: 0938-1328

Federal Form Document

Forms and Documents

Document Name	Status
Form CMS-10628 State Implemented Moratorium Form Form and Instruction	Modified
CMS-10628 - Supporting Statement for Enrollment Moratorium R.docx Supporting Statement A	2023-01-20

IC Document Collections

IC ID	Document Title	Status
224647	State Implemented Moratorium Form Form and Instruction	Modified