OMB control number
Insurance Common Claims Form and Supporting Regulations at 42 CFR Part 424 Subpart C
OMB 0938-0999 · HHS/CMS.
OMB 0938-0999
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form CMS-1500(08-05) Insurance Common Claims Form and Supporting Regulations at 42 CFR Part 424 Subpart C | Form and Instruction |
 CMS-1500(08-05).Record of Information Clearances.docx | Supplementary Document |
| CMS-1500(0805)_Supporting_Statement_Part_A.pdf | Supporting Statement A |
 Insurance Common Claims Form and Supporting Regulations at 42 CFR Part 424 Subpart C |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 201211-0938-010 | Reinstatement without change of a previously approved collection | 2012-11-28 | Approved without change | |
| 200706-0938-011 | Extension without change of a currently approved collection | 2007-06-29 | Approved without change | |
| 200606-0938-013 | New collection (Request for a new OMB Control Number) | 2006-06-27 | Approved without change |