Crosswalk

CMS-10718 CY 2023 MEDICARE ADVANTAGE AND MEDICARE PRECRIPTION DRUG PLAN ENROLLMENT FORM CROSSWALK

	Location on CY 2023 Enrollment Form
What’s your race? Select all that apply. 0 American Indian or Alaska Native 0 Asian Indian 0 Black or African American 0 Chinese 0 Filipino 0 Guamanian or Chamorro 0 Japanese 0 Korean 0 Native Hawaiian 0 Other Asian 0 Other Pacific Islander 0 Samoan 0 Vietnamese 0 White 0 I choose not to answer.	Page 3 - Section 2	What’s your race? Select all that apply. 0 American Indian or Alaska Native Asian: 0 Asian Indian 0 Chinese 0 Filipino 0 Japanese 0 Korean 0 Vietnamese 0 Other Asian 0 Black or African American Native Hawaiian and Pacific Islander: 0 Guamanian or Chamorro 0 Native Hawaiian 0 Samoan 0 Other Pacific Islander 0 White 0 I choose not to answer.	Rev	OMB’s terms of clearance for the approved information collection, Medicare Part C and Medicare Part D Enrollment Form Interviews (CMS-10816, OMB 0938-1440), required that CMS submit non-substantial change requests to revise its new race question to ensure appropriate and tested alphabetization of race categories with nested sub-categories of race rather than alphabetization of all sub-categories together.	Page 3 - Section 2

Type of Change: Rev = Revision, Del = Deletion, Add = Addition, and Red = Redesignation.