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CMS-10106_Supporting_Statement_Part_A (final)
CMS-10106_Supporting_Statement_Part_A (final).docx
Medicare Authorization to Disclose Personal Health Information (CMS-10106)
OMB: 0938-0930
OMB.report
HHS/CMS
OMB 0938-0930
ICR 202305-0938-012
CMS-10106_Supporting_Statement_Part_A (final)
( Supporting Statement A )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-0930 can be found here:
2025-11-20 - Revision of a currently approved collection
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