OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

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

OMB 0938-0484 · HHS/CMS.

OMB 0938-0484

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
CMS-R-96.Supporting Statement.5-30-06.docSupporting Statement A
Emergency and Foreign Hospital Services - Beneficiary Statement in Canadian/Mexican Travel Claims and Supporting Regulations in 42 CFR, Section 424.123 Information collection

All Historical Document Collections

Historical document collections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