Application for Enrollment in Part B Immunosuppressive Drug Coverage (Part B-ID) (CMS-10798)

ICR 202302-0938-010

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1428 can be found here:

Forms and Documents

Document Name	Status
Form CMS-10798 Application for Enrollment in Part B Immunosuppressive Drug Coverage (Part B-ID) Form and Instruction	Modified
CMS-10798 - Supporting Statement A (CMS-4199-F version 6.1).docx Supporting Statement A	2022-10-28
Response to Comments OMB 0938 1428.pdf Supplementary Document	2022-10-20

IC Document Collections

IC ID	Document Title	Status
254490	Application for Enrollment in Part B Immunosuppressive Drug Coverage (Part B-ID) Form and Instruction	Modified

ICR Details