Information Collection Request
Fast Appeals Notices: NOMNC/DENC (CMS-10123/10124)
ICR 202407-0938-011 · OMB 0938-0953 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 NOMNC-DENC_supportingstatement_2024_.docx |
Supporting Statement A | Uploaded 2024-08-07 | Repair queued |
 NOMNC_2024_Crosswalk_508.pdf |
Supplementary Document | Uploaded 2024-07-12 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 8809 |  Notice of Provider Non-Coverage (CMS-10123) |
Instruction | Modified | |
| 184965 | Detailed Explanation of Non-Coverage (CMS-10124) |
Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-0953 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 202012-0938-012 |
| Agency Tracking No | CM-CPC |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |