Supporting Statement for Agent/Broker Consent Information Collection (CMS-10840)

ICR 202304-0938-025

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1438 can be found here:

Forms and Documents

Document Name	Status
Form CMS-10840 Agent/Broker Eligibility and Consent Records Form and Instruction	New
Form CMS-10840 Agent/Broker Eligibility and Consent Documentation Form	Modified
Appendix_A_CMS-10840_Agent-Broker_Consent_60-Day_Comment_Response_508.pdf Supplementary Document	2023-04-27
CMS-10840_Agent-Broker Consent_Supporting Statement.docx Supporting Statement A	2023-04-27

IC Document Collections

IC ID	Document Title	Status
259918	Agent/Broker Eligibility and Consent Records Form and Instruction	New
257714	Agent/Broker Eligibility and Consent Documentation Form	Modified

ICR Details