Emergency and Foreign Hospital Services Beneficiary Statement in Canadian/Mexican Travel Claims and Supporting Regulations in 42 CFR, Section 424.123

OMB 0938-0484

Latest Forms, Documents, and Supporting Material

Document Name
CMS-R-96.Supporting Statement.5-30-06.doc Supporting Statement A
Emergency and Foreign Hospital Services - Beneficiary Statement in Canadian/Mexican Travel Claims and Supporting Regulations in 42 CFR, Section 424.123

200609-0938-002 Approved without change	Extension without change of a currently approved collection	2006-09-15
200302-0938-005 Approved with change	Extension without change of a currently approved collection	2003-02-21
200001-0938-007 Approved without change	Extension without change of a currently approved collection	2000-01-19
199612-0938-001 Approved without change	Extension without change of a currently approved collection	1996-12-13
199401-0938-002 Approved without change	Reinstatement with change of a previously approved collection	1994-01-31
199009-0938-004 Approved without change	Reinstatement with change of a previously approved collection	1990-09-25
198606-0938-010 Approved without change	New collection (Request for a new OMB Control Number)	1986-06-26