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CMS-10636 Exception Request Template
Triennial Network Adequacy Review for Medicare Advantage Organizations and 1876 Cost Plans (CMS-10636)
MA_Exception_Request_Template_(CMS-4201-P version 1)
Three-Year Network Adequacy Review for Medicare Advantage Organizations
OMB: 0938-1346
OMB.report
HHS/CMS
OMB 0938-1346
ICR 202303-0938-009
IC 227912
CMS-10636 Exception Request Template
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-1346 can be found here:
2023-09-25 - Revision of a currently approved collection
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