OMB control number
Optional Dental-only Supplemental Coverage SPA Template (CMS-10289)
OMB 0938-1075 · HHS/CMS.
OMB 0938-1075
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form CMS-100289 Optional Dental-only Supplemental Coverage SPA Template (CMS-10289) | Form and Instruction |
 CMS-10289 Optional Dental-only Justification for Non-Material change.doc | Justification for No Material/Nonsubstantive Change |
| Draft CHIP SPA Dental Template (2)-TRC.docx | Supplementary Document |
 Optional Dental-only Supplemental Coverage SPA Template (CMS-10289) |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 201011-0938-001 | No material or nonsubstantive change to a currently approved collection | 2010-11-02 | Approved without change | |
| 200910-0938-004 | New collection (Request for a new OMB Control Number) | 2009-10-16 | Approved without change |