OMB
.report
Search
Transitional Coverage and Retroactive Medicare Part D Coverage for Certain Low-Income Beneficiaries through the Limited Income Newly Eligible Transition (LI NET) Program (CMS-10831)
ICR 202408-0938-003
OMB: 0938-1441
Federal Form Document
OMB.report
HHS/CMS
OMB 0938-1441
ICR 202408-0938-003
( )
Forms and Documents
Document
Name
Status
Form CMS-10831 Beneficiaries
Form and Instruction
Modified
CMS-10831_LI NET DirectReimbReq 2025v3 Crosswalk_508.pdf
Supplementary Document
2024-08-06
CMS-10831_LI NET ApplForm 2025v3 Crosswalk_508.pdf
Supplementary Document
2024-08-06
CMS-10831_Supporting Statement__a.docx
Supporting Statement A
2024-08-06
IC Document Collections
IC ID
Document
Title
Status
257782
Sponsor (Report to CMS)
Unchanged
257781
Pharmacists (Fax the Documentation to the LI NET Sponsor)
Unchanged
257780
Beneficiaries
Form and Instruction
Modified
ICR Details
© 2024 OMB.report |
Privacy Policy