Information Collection Request
Supporting Statement for Agent/Broker Consent Information Collection (CMS-10840)
ICR 202301-0938-001 · OMB 0938-1438 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1438 can be found here:
Forms and Documents
Document Name | Status |
|---|---|
Form |
New |
Supporting Statement A | 2023-01-04 |
Form CMS-10840 Agent/Broker Consent
CMS-10840_Agent-Broker_Consent_Supporting_Statement.docxIC Document Collections
| IC ID | Document Title | Status | |
|---|---|---|---|
| 257714 | New |
Agent/Broker ConsentICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1438 |
| Type of Information Collection | New collection (Request for a new OMB Control Number) |
| Agency Tracking No | CCIIO |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |