ADA Dental Claim Form (CMS-10883)

ICR 202403-0938-016

Forms and Documents

Document Name	Status
Form CMS-10883 Paper Submission Form and Instruction	New
Form CMS-10883 Electronic Submission Form and Instruction	New
CMS-10883.Supporting Statement Part A (3-28-24).docx Supporting Statement A	2024-03-29

IC Document Collections

IC ID	Document Title	Status
266388	Paper Submission Form and Instruction	New
266385	Electronic Submission Form and Instruction	New

ICR Details