OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Application For Medicare Part A and Part B Special Enrollment Period (Exceptional Circumstances) (CMS-10797)

ICR 202501-0938-010 · OMB 0938-1426 · Received in OIRA

Forms and Documents
Document
Name
Status
Form and Instruction
 Modified
Supporting Statement A
2025-03-21
Supplementary Document
2025-01-22
IC Document Collections
IC ID
Document
Title
Status
254496 Modified
ICR Details
StatusReceived in OIRA
Agency/SubagencyHHS/CMS
OMB Control No0938-1426
Type of Information CollectionReinstatement with change of a previously approved collection
Previous ICR Reference No202210-0938-009
Agency Tracking NoCM-CPC
Date Submitted to OIRA1969-12-31
Requested Expiration Date1969-12-31