Document
Summary of Benefits and Coverage Example AI/AN Limited Cost Sharing
ICR 202504-0938-009 · OMB 0938-1146 · Object 156373101.
Document Viewer [docx]
Status: The document is viewable, but some background extraction is still pending.
Queue: Repair is in progress, but the document is still incomplete and remains in the worker queue. (priority 70 · next 2026-05-04 13:58:04)
Missing: html
Download: Source copy (docx)
Loading document viewer…
Document Metadata
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | Summary of Benefits and Coverage Example AI/AN Limited Cost Sharing |
| Subject | Example SBC of AI/AN Limited Cost Sharing |
| Author | CMS |
| File Created | 2025-07-27 |
| Conversion State | partial |