Information Collection Request
Notice of Denial of Medical Coverage (or Payment) (NDMCP) (CMS-10003)
ICR 202303-0938-003 · OMB 0938-0829 · Active
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-0829 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10003 Notice of Denial of Medical Coverage (or Payment) |
Form | Modified | Available |
| Form CMS-10003 Notice of Denial of Medical Coverage (or Payment) |
Form | Modified | Repair queued |
 Non-sub Change Request Memo - NDMCP Spanish.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2023-03-01 | Available |
| Non-sub Change Request Memo - NDMCP Spanish.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2023-03-01 | Repair queued |
| CMS-10003 - Supporting Statement A_clean508.docx |
Supporting Statement A | Uploaded 2022-11-16 | Available |
| CMS-10003 - Supporting Statement A_clean508.docx |
Supporting Statement A | Uploaded 2022-11-16 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 8626 |  Notice of Denial of Medical Coverage (or Payment) |
Form | Modified | |
| 8626 | Notice of Denial of Medical Coverage (or Payment) |
Form | Modified |
ICR Details
| Status | Active |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-0829 |
| Type of Information Collection | No material or nonsubstantive change to a currently approved collection |
| Previous ICR Reference No | 202211-0938-002 |
| Agency Tracking No | CM-CPC |
| Date Submitted to OIRA | 2023-03-02 |
| Requested Expiration Date | 1969-12-31 |