Medicare EDI Enrollment Form and EDI Registration (CMS-10164 A/B)

ICR 202405-0938-014

OMB: 0938-0983

Federal Form Document

Forms and Documents

Document Name	Status
Form CMS-10164A Medicare EDI Enrollment Form and EDI Registration Form	Modified
CMS-10164 A&B.Supporting Statement Part A (final).docx Supporting Statement A	2024-05-15

IC Document Collections

IC ID	Document Title	Status
8845	Medicare EDI Enrollment Form and EDI Registration Form	Modified