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 Name |
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Form and Instruction |
Justification for No Material/Nonsubstantive Change |
Supplementary Document |
Form CMS-100289 Optional Dental-only Supplemental Coverage SPA Template (CMS-10289)
CMS-10289 Optional Dental-only Justification for Non-Material change.doc
Optional Dental-only Supplemental Coverage SPA Template (CMS-10289) All Historical Document Collections
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Approved without change |
No material or nonsubstantive change to a currently approved collection | 2010-11-02 | |
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Approved without change |
New collection (Request for a new OMB Control Number) | 2009-10-16 |