Information Collection Request
Initial Request for State Implemented Moratorium Form (CMS-10628)
ICR 202301-0938-007 · OMB 0938-1328 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1328 can be found here:
Forms and Documents
Document Name | Status |
|---|---|
Form and Instruction |
Modified |
Supporting Statement A | 2023-01-20 |
Form CMS-10628 State Implemented Moratorium Form
CMS-10628 - Supporting Statement for Enrollment Moratorium R.docxIC Document Collections
| IC ID | Document Title | Status | |
|---|---|---|---|
| 224647 | Modified |
State Implemented Moratorium FormICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1328 |
| Type of Information Collection | Reinstatement without change of a previously approved collection |
| Previous ICR Reference No | 201611-0938-020 |
| Agency Tracking No | CPI -10628 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |