Information Collection Request
Application for Enrollment in Part B Immunosuppressive Drug Coverage (Part B-ID) (CMS-10798)
ICR 202302-0938-012 · OMB 0938-1428 · 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⚠️ Notice: This information collection may be outdated.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 |
| Form CMS-10798 Application for Enrollment in Part B Immunosuppressive Drug Coverage (Part B-ID) |
Form and Instruction | Modified | Repair queued |
 Non-sub Change Request Memo CMS 10798_clean.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2023-02-15 | Available |
| Non-sub Change Request Memo CMS 10798_clean.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2023-02-15 | Repair queued |
| CMS-10798 - Supporting Statement A.docx |
Supporting Statement A | Uploaded 2023-02-15 | Available |
| CMS-10798 - Supporting Statement A.docx |
Supporting Statement A | Uploaded 2023-02-15 | Repair queued |
| Crosswalk of Changes CMS 10798 OMB 0938 1428.docx |
Supplementary Document | Uploaded 2023-02-15 | Repair queued |
| Crosswalk of Changes CMS 10798 OMB 0938 1428.docx |
Supplementary Document | Uploaded 2023-02-15 | Repair queued |
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 | |
| 254490 | Application for Enrollment in Part B Immunosuppressive Drug Coverage (Part B-ID) |
Form and Instruction | Modified |
ICR Details
| Status | Active |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1428 |
| Type of Information Collection | No material or nonsubstantive change to a currently approved collection |
| Previous ICR Reference No | 202302-0938-010 |
| Agency Tracking No | CM-CPC |
| Date Submitted to OIRA | 2023-02-16 |
| Requested Expiration Date | 1969-12-31 |