Initial Request for State Implemented Moratorium Form (CMS-10628)

OMB 0938-1328

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-10628 State Implemented Moratorium Form Form and Instruction
CMS-10628 - Supporting Statement for Enrollment Moratorium R.docx Supporting Statement A
State Implemented Moratorium Form Form and Instruction

All Historical Document Collections

202301-0938-007 Approved without change	Reinstatement without change of a previously approved collection	2023-01-24
201611-0938-020 Approved with change	New collection (Request for a new OMB Control Number)	2016-12-12