OMB control number
Federal Reimbursement Of Emergency Health Services Furnished To Undocumented Aliens (section 1011) Provider Enrollment Application
OMB 0938-0929 · HHS/CMS.
OMB 0938-0929
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form CMS-10115 FEDERAL REIMBURSEMENT OF EMERGENCY HEALTH SERVICES FURNISHED TO UNDOCUMENTED ALIENS (SECTION 1011) PROVIDER ENROLLMENT APPLICATION (CMS-10115) | Form and Instruction |
 Crosswalk_JA 03212013.doc | Supplementary Document |
| JUSTIFICATION_for_REQUESTING_SOC_SEC_NOS_MED_JA 03212013.doc | Supplementary Document |
| CMS-10115_PRA_Supporting_Statement_MED [rev 7-18-2013 by OSORA PRA].doc | Supporting Statement A |
 FEDERAL REIMBURSEMENT OF EMERGENCY HEALTH SERVICES FURNISHED TO UNDOCUMENTED ALIENS (SECTION 1011) PROVIDER ENROLLMENT APPLICATION (CMS-10115) |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 201307-0938-009 | Reinstatement without change of a previously approved collection | 2013-07-19 | Approved without change | |
| 200804-0938-004 | Revision of a currently approved collection | 2008-04-25 | Approved with change | |
| 200512-0938-013 | No material or nonsubstantive change to a currently approved collection | 2005-12-01 | Approved without change | |
| 200502-0938-010 | Extension without change of a currently approved collection | 2005-02-25 | Approved without change | |
| 200408-0938-007 | New collection (Request for a new OMB Control Number) | 2004-08-31 | Approved with change |