Medicare Change of Status Notice (MCSN) (CMS-10868)

ICR 202401-0938-012

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1467 can be found here:

Forms and Documents

Document Name	Status
Form CMS-10868 Medicare Change of Status Notice (MCSN) Form	New
CMS-10868 - Supporting Statement_A (CMS-4204-P version 2) (updated).docx Supporting Statement A	2024-01-26

IC Document Collections

IC ID	Document Title	Status
264658	Medicare Change of Status Notice (MCSN) Form	New

ICR Details