OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Detailed Explanation of Non-Coverage (CMS-10124)

IC 184965 under ICR 202407-0938-011 · OMB 0938-0953.

Documents and Forms
Document Name
Document Type
Instruction
Instruction
Form
Form
Form
Form
Information Collection (IC) Details

View Information Collection (IC)

Detailed Explanation of Non-Coverage (CMS-10124)
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 405.1200 42 CFR 405.1202

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction DENC_instructions_2024_.docx No   Fillable Printable
Form CMS-10124 Detailed Explanation of Non-coverage (DENC) [English] DENC_2024_.docx No   Fillable Printable
Form CMS-10124 Explicación Detallada No-Cobertura (DENC) [Spanish] DENC_2024_Spanish_.docx No   Fillable Printable

Health Health Care Services

 

26,399 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 369,755 0 218,355 0 0 151,400
Annual IC Time Burden (Hours) 472,305 0 283,055 0 0 189,250
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.