OMB control number
Medicare Part C and Medicare Part D Enrollment Form Interviews (CMS-10816)
OMB 0938-1440 · HHS/CMS.
OMB 0938-1440
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form CMS-10816 Interview Guide | Form and Instruction |
| Form CMS-10816 Invitation & Screening | Form and Instruction |
 CMS 10816 - Non-Sub Change Request Memo for Additional Interviews.docx | Justification for No Material/Nonsubstantive Change |
| Attachment B_CMS 10816 - Item Crosswalk.docx | Supplementary Document |
| Responses to OMB comments 030323.docx | Supplementary Document |
| Attachment C_CMS-10816 - Supporting Statement A_Non sub requestv2.docx | Supporting Statement A |
| Attachment D_CMS-10816 Supporting Statement B_Non sub request.docx | Supporting Statement B |
| CMS Response to CMS-10816 60-day Public Comments 11.14.22 Final.docx | Supplementary Document |
 Interview Guide |
Form and Instruction |
| Invitation & Screening |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202312-0938-005 | No material or nonsubstantive change to a currently approved collection | 2023-12-08 | Approved without change | |
| 202211-0938-013 | New collection (Request for a new OMB Control Number) | 2022-11-29 | Approved with change |