Information Collection Request
Medicare Change of Status Notice (MCSN) (CMS-10868)
ICR 202401-0938-012 · OMB 0938-1467 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1467 can be found here:
Forms and Documents
Document Name | Status |
|---|---|
Form |
New |
Supporting Statement A | 2024-01-26 |
Form CMS-10868 Medicare Change of Status Notice (MCSN)
CMS-10868 - Supporting Statement_A (CMS-4204-P version 2) (updated).docxIC Document Collections
| IC ID | Document Title | Status | |
|---|---|---|---|
| 264658 | New |
Medicare Change of Status Notice (MCSN)ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1467 |
| Type of Information Collection | New collection (Request for a new OMB Control Number) |
| Agency Tracking No | CM-CPC |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |