Request of Extension of Time Periods for Extenuating Circumstances

No Surprises Act: IDR Process

OMB: 1210-0169

IC ID: 249371

Documents and Forms

Document Name Document Type
13. Appendix-13 Request for Extension Notice.docx Other-Request of Extension of Time Periods for Extenuating Circumstances
CMS-10791 - Appendix 13 Request for Extension Notice.pdf Other-Request for Extension Notice