Information Collection Request
ADA Dental Claim Form (CMS-10883)
ICR 202403-0938-016 · OMB 0938-1471 · Received in OIRA
Forms and Documents
Document Name | Status |
|---|---|
Form and Instruction |
New |
Form and Instruction |
New |
Supporting Statement A | 2024-03-29 |
Form CMS-10883 Paper Submission
CMS-10883.Supporting Statement Part A (3-28-24).docxIC Document Collections
| IC ID | Document Title | Status | |
|---|---|---|---|
| 266388 | New | ||
| 266385 | New |
Paper SubmissionICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1471 |
| Type of Information Collection | New collection (Request for a new OMB Control Number) |
| Agency Tracking No | OIT |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |