OMB control number
Waiver Application for Providers and Suppliers Subject to an Enrollment Moratorium (CMS-10629)
OMB 0938-1313 · HHS/CMS.
OMB 0938-1313
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form CMS-10629 Waiver Application | Form and Instruction |
| CMS-10629 - Supporting Statement for Enrollment Moratorium - Final 523.docx | Supporting Statement A |
 Waiver Application |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 201703-0938-007 | Reinstatement without change of a previously approved collection | 2017-03-07 | Approved with change | |
| 201608-0938-002 | New collection (Request for a new OMB Control Number) | 2016-08-04 | Approved without change |