Dual Eligible Special Needs Plan Contract with the State Medicaid Agency (CMS-10796)

OMB 0938-1410

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-10796 Dual Eligible Special Needs Plan Contract with the State Medicaid Agency Form and Instruction
CMS-10796 - Supporting Statement A (CMS-4192-F).docx Supporting Statement A
Dual Eligible Special Needs Plan Contract with the State Medicaid Agency Form and Instruction

All Historical Document Collections

202206-0938-002 Approved without change	New collection (Request for a new OMB Control Number)	2022-06-01
202201-0938-009 Comment filed on proposed rule	New collection (Request for a new OMB Control Number)	2022-01-13