Information Collection Request
Medicare Change of Status Notice (MCSN) (CMS-10868)
ICR 202401-0938-012 · OMB 0938-1467 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1467 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10868 Medicare Change of Status Notice (MCSN) |
Form | New | Repair queued |
 CMS-10868 - Supporting Statement_A (CMS-4204-P version 2) (updated).docx |
Supporting Statement A | Uploaded 2024-01-26 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 264658 |  Medicare Change of Status Notice (MCSN) |
Form | New |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1467 |
| Type of Information Collection | New collection (Request for a new OMB Control Number) |
| Agency Tracking No | CM-CPC |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |