OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Application for Coverage in the Pre-Existing Condition Insurance Plan

OMB 0938-1095 · HHS/CMS.

OMB 0938-1095

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form CMS-10334 Premium Payment BurdenForm and Instruction
Form CMS-10334 Application and Eligibility BurdenForm and Instruction
Form CMS-10334 Premium Payment (2013)Form and Instruction
Form CMS-10334 Application and Eligibility (2013)Form and Instruction
Form CMS-10334 Premium Payment (2012)Form and Instruction
Form CMS-10334 Application and Eligibility (2012)Form and Instruction
Form CMS-10334 Premium Payment (2011)Form and Instruction
Form CMS-10334 Application and Eligibility (2011)Form and Instruction
Form CMS-10334 Premium Payment (2010)Form and Instruction
Form CMS-10334 Application and Eligibility (2010)Form and Instruction
CMS-10334 Supporting_Statement_Part_A(CLEAN 1-30-12).docxSupporting Statement A
Premium Payment Burden Form and Instruction
Application and Eligibility Burden Form and Instruction
Premium Payment (2013) Form and Instruction
Application and Eligibility (2013) Form and Instruction
Premium Payment (2012) Form and Instruction
Application and Eligibility (2012) Form and Instruction
Premium Payment (2011) Form and Instruction
Application and Eligibility (2011) Form and Instruction
Premium Payment (2010) Form and Instruction
Application and Eligibility (2010) Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
201112-0938-007 Revision of a currently approved collection 2011-12-19 Approved with change
201111-0938-005 No material or nonsubstantive change to a currently approved collection 2011-11-08 Approved without change
201106-0938-014 No material or nonsubstantive change to a currently approved collection 2011-06-15 Approved without change
201104-0938-001 No material or nonsubstantive change to a currently approved collection 2011-04-08 Approved without change
201102-0938-009 No material or nonsubstantive change to a currently approved collection 2011-02-16 Approved without change
201012-0938-020 Extension without change of a currently approved collection 2010-12-30 Approved without change
201008-0938-016 No material or nonsubstantive change to a currently approved collection 2010-08-23 Approved without change
201006-0938-012 New collection (Request for a new OMB Control Number) 2010-06-25 Approved with change