OMB control number
Medicare Advantage & Part D Disenrollment Requests Through 1-800-MEDICARE
OMB 0938-0741 · HHS/CMS.
OMB 0938-0741
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Attmt A_required elements_7-10-08.doc | Supplementary Document |
| Response to Social Security number collection.doc | Supplementary Document |
| 1-800_MAPDP_disenrollment-PRA_SS_7-10-08.doc | Supporting Statement A |
 Medicare Advantage & Part D Disenrollment Requests Through 1-800-MEDICARE (CMS-R-257) |
Other-Script |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 200811-0938-001 | Revision of a currently approved collection | 2008-11-04 | Approved with change | |
| 200510-0938-014 | Extension without change of a currently approved collection | 2005-10-26 | Approved without change | |
| 200210-0938-007 | Extension without change of a currently approved collection | 2002-10-30 | Approved without change | |
| 199901-0938-009 | Extension without change of a currently approved collection | 1999-01-28 | Approved without change | |
| 199809-0938-002 | New collection (Request for a new OMB Control Number) | 1998-09-22 | Approved without change |