OMB control number
Coverage of Certain Preventive Services Under the Affordable Care Act (CMS-10459)
OMB 0938-1292 · HHS/CMS.
OMB 0938-1292
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form CMS-10459 Self-Certification | Form and Instruction |
| Form CMS-10459 Notice of Availability of Separate Payments for Contraceptive Services | Form and Instruction |
 CMS-10459 Supporting Statement FINAL .docx | Supporting Statement A |
 Self-Certification |
Form and Instruction |
| Notice of Availability of Separate Payments for Contraceptive Services |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 201509-0938-010 | New collection (Request for a new OMB Control Number) | 2015-09-23 | Approved with change |