Information Collection Request
Application for Enrollment in Part B Immunosuppressive Drug Coverage (Part B-ID) (CMS-10798)
ICR 202302-0938-010 · OMB 0938-1428 · Historical Active
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1428 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10798 Application for Enrollment in Part B Immunosuppressive Drug Coverage (Part B-ID) |
Form and Instruction | Modified | Available |
 CMS-10798 - Supporting Statement A (CMS-4199-F version 6.1).docx |
Supporting Statement A | Uploaded 2022-10-28 | Available |
 Response to Comments OMB 0938 1428.pdf |
Supplementary Document | Uploaded 2022-10-20 | Available |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 254490 |  Application for Enrollment in Part B Immunosuppressive Drug Coverage (Part B-ID) |
Form and Instruction | Modified |
ICR Details
| Status | Historical Active |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1428 |
| Type of Information Collection | New collection (Request for a new OMB Control Number) |
| Previous ICR Reference No | 202210-0938-008 |
| Agency Tracking No | CM-CPC |
| Date Submitted to OIRA | 2023-02-14 |
| Requested Expiration Date | 1969-12-31 |