Information Collection Request
Supporting Statement for Agent/Broker Consent Information Collection (CMS-10840)
ICR 202304-0938-025 · OMB 0938-1438 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1438 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10840 Agent/Broker Eligibility and Consent Records |
Form and Instruction | New | Repair queued |
| Form CMS-10840 Agent/Broker Eligibility and Consent Documentation |
Form | Modified | Repair queued |
 Appendix_A_CMS-10840_Agent-Broker_Consent_60-Day_Comment_Response_508.pdf |
Supplementary Document | Uploaded 2023-04-27 | Repair queued |
 CMS-10840_Agent-Broker Consent_Supporting Statement.docx |
Supporting Statement A | Uploaded 2023-04-27 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 259918 |  Agent/Broker Eligibility and Consent Records |
Form and Instruction | New | |
| 257714 | Agent/Broker Eligibility and Consent Documentation |
Form | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1438 |
| Type of Information Collection | New collection (Request for a new OMB Control Number) |
| Previous ICR Reference No | 202301-0938-001 |
| Agency Tracking No | CCIIO |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |