OMB control number
Medicare Enrollment Application for Registration of Eligible Entities That Provide Health Insurance Coverage Complementary to Medicare Part B and Supporting Regulations
OMB 0938-1233 · HHS/CMS.
OMB 0938-1233
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form CMS-855C Change of Information | Form and Instruction |
| Form CMS-855C Initial Registration | Form and Instruction |
 CMS 855C.Supporting Statement Part A.doc | Supporting Statement A |
 Change of Information |
Form and Instruction |
| Initial Registration |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 201311-0938-011 | New collection (Request for a new OMB Control Number) | 2013-11-12 | Approved without change |