Information Collection Request

Application for Enrollment in Part B Immunosuppressive Drug Coverage (Part B-ID) (CMS-10798)

ICR 202302-0938-010 · OMB 0938-1428 · Historical Active

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1428 can be found here:

Forms and Documents

Document Name	Status
Form CMS-10798 Application for Enrollment in Part B Immunosuppressive Drug Coverage (Part B-ID) Form and Instruction	Modified
CMS-10798 - Supporting Statement A (CMS-4199-F version 6.1).docx Supporting Statement A	2022-10-28
Response to Comments OMB 0938 1428.pdf Supplementary Document	2022-10-20

IC Document Collections

IC ID	Document Title	Status
254490	Application for Enrollment in Part B Immunosuppressive Drug Coverage (Part B-ID) Form and Instruction	Modified

ICR Details

Status	Historical Active
Agency/Subagency	HHS/CMS
OMB Control No	0938-1428
Type of Information Collection	New collection (Request for a new OMB Control Number)
Previous ICR Reference No	202210-0938-008
Agency Tracking No	CM-CPC
Date Submitted to OIRA	2023-02-14
Requested Expiration Date	1969-12-31