OMB control number
Pre-Existing Condition Insurance Plan (PCIP) HIPAA Authorization Form
OMB 0938-1161 · HHS/CMS.
OMB 0938-1161
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form CMS-10428 PCIP Authorization Form | Form and Instruction |
 Justification of Non-material change.docx | Justification for No Material/Nonsubstantive Change |
 PCIP Authorization Form |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 201306-0938-009 | No material or nonsubstantive change to a currently approved collection | 2013-06-18 | Approved without change | |
| 201304-0938-003 | Reinstatement without change of a previously approved collection | 2013-04-05 | Approved without change | |
| 201203-0938-010 | New collection (Request for a new OMB Control Number) | 2012-03-19 | Approved without change |